ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies

TLDR

The guidelines aim to update ESICM’s 2017 clinical practice guideline. They were developed by an international expert panel using systematic review methods (PRISMA), GRADE, and EQUATOR guidelines to assess evidence for non‑pharmacological respiratory support in adult ARDS, including COVID‑19. The CPG presents 21 recommendations covering ARDS definition, phenotyping, and non‑pharmacological respiratory support—including HFNO, NIV, tidal volume, PEEP, recruitment maneuvers, prone positioning, neuromuscular blockade, and ECLS—alongside expert opinion and research priorities.

Abstract

The aim of these guidelines is to update the 2017 clinical practice guideline (CPG) of the European Society of Intensive Care Medicine (ESICM). The scope of this CPG is limited to adult patients and to non-pharmacological respiratory support strategies across different aspects of acute respiratory distress syndrome (ARDS), including ARDS due to coronavirus disease 2019 (COVID-19). These guidelines were formulated by an international panel of clinical experts, one methodologist and patients' representatives on behalf of the ESICM. The review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations and the quality of reporting of each study based on the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) network guidelines. The CPG addressed 21 questions and formulates 21 recommendations on the following domains: (1) definition; (2) phenotyping, and respiratory support strategies including (3) high-flow nasal cannula oxygen (HFNO); (4) non-invasive ventilation (NIV); (5) tidal volume setting; (6) positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM); (7) prone positioning; (8) neuromuscular blockade, and (9) extracorporeal life support (ECLS). In addition, the CPG includes expert opinion on clinical practice and identifies the areas of future research.