Treatment of Unspecified Respiratory Failure in Acute Respiratory Distress Syndrome (PaO2/FIO2 ≤ 300, PEEP/CPAP ≥ 5 cmH2O)
This protocol applies to unspecified respiratory failure presenting within the clinical picture of acute respiratory distress syndrome (ARDS), defined according to the Berlin criteria.
All four Berlin criteria must be met: a PaO2/FIO2 ratio ≤ 300 under PEEP or 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.
Moderate-to-severe ARDS is managed through lung-protective ventilation strategies, combined with specific positional interventions and adjunctive pharmacologic measures — the full structured protocol details the complete sequence and parameters.
References
DOI: 10.1186/s40560-023-00658-3
The 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.
Limiting plateau pressure and high-level PEEP is recommended weakly to strongly in all guidelines, although the most recent Cochrane analysis did not find a survival benefit for high-level PEEP.
Prone position ventilation with prolonged hours is weakly to strongly recommended for moderate-to-severe ARDS in all guidelines.
Early and limited use of muscle relaxants are weakly to strongly recommended for patients with moderate to severe ARDS.
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