Treatment of Unspecified Respiratory Failure in Acute Respiratory Distress Syndrome (ARDS)
This protocol addresses unspecified respiratory failure in the specific clinical context of acute respiratory distress syndrome (ARDS) as defined by the Berlin criteria — a distinct, acute presentation requiring structured management.
Clinical Scenario
The Berlin definition identifies ARDS when all four of the following are present: PaO2/FIO2 ratio ≤ 300 under PEEP/CPAP ≥ 5 cmH2O; acute onset within one week; bilateral shadows in the lung fields; and respiratory failure that cannot be explained by cardiac failure or excess fluid alone.
Management Approach
Initial management centres on positive pressure ventilation — with specific ventilatory strategy and fluid management approaches constituting the core of care. The full protocol details the conditions under which both invasive and noninvasive options apply, and the supporting adjunct strategies.
References
DOI: 10.1186/s40560-023-00658-3The clinical diagnosis of ARDS is currently based on the Berlin definition: (1) PaO2/FIO2 ratio ≤ 300 under positive end-expiratory pressure (PEEP)/continuous positive airway pressure (CPAP) ≥ 5 cmHO2; (2) acute onset within a week; (3) bilateral shadows in the lung fields, and (4) respiratory failure that cannot be explained by cardiac failure or excess fluid alone.
Regarding ARDS, IPPV has been the gold standard; however, HFNC and NPPV are weakly recommended as alternative options to initial management in JRS/JSICM/JSRCM-GL2021.
Low tidal volume ventilation is weakly recommended for ARF in SSCG2021 and SRLF-GL2019, and strongly recommended for ARDS in JRS/JSICM/JSRCM-GL2021, SSCG2021, SRLF-GL2019 and FICM/ICS-GL2018.
Based on this evidence, the JRS/JSICM/JSRCM-GL2021 and FICM/ICS-GL 2018 weakly recommend restrictive fluid management.
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