?? Paper of the day
Prashant Nasa
ICU Physician - Co-editor: Rational use of IV Fluids in Critically ill (link in bio)- PROVE Network - Delphi Methodology - Fluid and Oxygen are Drugs - X: @drnasap
An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline
Published in: American Journal of Respiratory Critical Care Medicine
Summary:
This article is an update on the management of adult patients with acute respiratory distress syndrome (ARDS), as per the official American Thoracic Society Clinical Practice Guideline. The update incorporates new evidence addressing the use of corticosteroids, venovenous extracorporeal membrane oxygenation (VV-ECMO), neuromuscular blocking agents, and positive end-expiratory pressure (PEEP).
Key takeaways:
1??The guideline suggests the use of corticosteroids for patients with ARDS, with a conditional recommendation and moderate certainty of evidence.
2?? It also suggests the use of VV-ECMO in selected patients with severe ARDS, with a conditional recommendation and low certainty of evidence.
3?? Other recommendations include the use of neuromuscular blockers in patients with early severe ARDS, higher PEEP without lung recruitment maneuvers, and against using prolonged lung recruitment maneuvers in patients with moderate to severe ARDS.
Counter arguments:1. The use of corticosteroids is suggested with a conditional recommendation due to uncertainties about the optimal dosing, timing, and safety profile.
2. Few recommendations are in disagreement to European Society of Intensive Care Medicine - ESICM guidelines on ARDS: PEEP and neuromuscular blocking agents,.