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

Giacomo Grasselli, Carolyn S Calfee, Luigi Camporota, Daniele Poole, Marcelo B P Amato, Massimo Antonelli, Yaseen M Arabi, Francesca Baroncelli, Jeremy R Beitler, Giacomo Bellani, Geoff Bellingan, Bronagh Blackwood, Lieuwe D J Bos, Laurent Brochard, Daniel Brodie, Karen E A Burns, Alain Combes, Sonia D'Arrigo, Daniel De Backer, Alexandre Demoule, Sharon Einav, Eddy Fan, Niall D Ferguson, Jean-Pierre Frat, Luciano Gattinoni, Claude Guérin, Margaret S Herridge, Carol Hodgson, Catherine L Hough, Samir Jaber, Nicole P Juffermans, Christian Karagiannidis, Jozef Kesecioglu, Arthur Kwizera, John G Laffey, Jordi Mancebo, Michael A Matthay, Daniel F McAuley, Alain Mercat, Nuala J Meyer, Marc Moss, Laveena Munshi, Sheila N Myatra, Michelle Ng Gong, Laurent Papazian, Bhakti K Patel, Mariangela Pellegrini, Anders Perner, Antonio Pesenti, Lise Piquilloud, Haibo Qiu, Marco V Ranieri, Elisabeth Riviello, Arthur S Slutsky, Renee D Stapleton, Charlotte Summers, Taylor B Thompson, Carmen S Valente Barbas, Jesús Villar, Lorraine B Ware, Björn Weiss, Fernando G Zampieri, Elie Azoulay, Maurizio Cecconi, European Society of Intensive Care Medicine Taskforce on ARDS, Giacomo Grasselli, Carolyn S Calfee, Luigi Camporota, Daniele Poole, Marcelo B P Amato, Massimo Antonelli, Yaseen M Arabi, Francesca Baroncelli, Jeremy R Beitler, Giacomo Bellani, Geoff Bellingan, Bronagh Blackwood, Lieuwe D J Bos, Laurent Brochard, Daniel Brodie, Karen E A Burns, Alain Combes, Sonia D'Arrigo, Daniel De Backer, Alexandre Demoule, Sharon Einav, Eddy Fan, Niall D Ferguson, Jean-Pierre Frat, Luciano Gattinoni, Claude Guérin, Margaret S Herridge, Carol Hodgson, Catherine L Hough, Samir Jaber, Nicole P Juffermans, Christian Karagiannidis, Jozef Kesecioglu, Arthur Kwizera, John G Laffey, Jordi Mancebo, Michael A Matthay, Daniel F McAuley, Alain Mercat, Nuala J Meyer, Marc Moss, Laveena Munshi, Sheila N Myatra, Michelle Ng Gong, Laurent Papazian, Bhakti K Patel, Mariangela Pellegrini, Anders Perner, Antonio Pesenti, Lise Piquilloud, Haibo Qiu, Marco V Ranieri, Elisabeth Riviello, Arthur S Slutsky, Renee D Stapleton, Charlotte Summers, Taylor B Thompson, Carmen S Valente Barbas, Jesús Villar, Lorraine B Ware, Björn Weiss, Fernando G Zampieri, Elie Azoulay, Maurizio Cecconi, European Society of Intensive Care Medicine Taskforce on ARDS

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.

Keywords: Acute hypoxemic respiratory failure; Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Mechanical ventilation; Non-invasive ventilation; Practice guidelines; Prognosis; Prone position.

Conflict of interest statement

GG received funding from Fischer&Paykel, MSD, Pfizer, and received fees from Getinge, Draeger Medical, Cook, MundiPharma, Fischer&Paykel, Pfizer. CSC received funding from National Institute of Health, Roche Genen Tech, Quantum Leap Health Care Collaborative and received fees from Cellenkos, Vasomune, NGM Bio, Gen1e Life Sciences. LC received fees from Draeger Medical, Hamilton, Medtronic. MA received funding from GE, Toray and received fees from Fischer&Paykel, Menarini, Pfizer. YMA is a Board member of International Severe Acute Respiratory and emerging Infection Consortium (ISARIC); is Co-Chair of International Study Steering Committee of O2CoV2 Study of World Health Organization and is PI of Helmet-COVID trial. JRB received funding from National Institute of Health, Quantum Leap Health Care Collaborative, Sedana Medical and received fees from Biomark Pharmaceutics. GB received royalties from Flowmeter Spa and received fees from Flowmeter Spa, Draeger Medical, Getinge. LDJB received funding from Amsterdam UMC, Longfonds, European Respiratory Society, Innovative Medicine Intiative, Santhera, ZonMW, and received fees from AstraZeneca, Bayer, Novartis, Santhera, Sobi, Scailyte. LB received funding from Draeger Medical, Medtronic, Stimit, Vitalair and received fees from Fischer&Paykel and received equipments from Fischer&Paykel, Sentec. DB is Extracorporeal Life Support Organization President-elect and member board of directors and Chair Executive Committee of ECMONet. He is in the Data Safety Monitoring Board of ECMO-Rehab Study, was in the Advisory Boards for Livanova, Abiomed, Xenios, Medtronic, Inspira, Cellenkos and received funding from Livanova and received fees from Livanova, Abiomed, Xenios, Inspira, Medtronic, Cellenkos. KEAB is President of Canadian Critical Care Society, Past-Chair of Women in Critical Care of the American Thoracic Society and ex-officio member of Canadian Critical Care Trials Group Executive; she received fees from Fischer&Paykel. AC received fees from Getinge, Baxter, Fresenius. AD received funding from Philips, French Ministry of Health, Respinor, Lungpacer, Assistance publique – Hôpitaux de Paris, and received fees from Lungpacer, Respinor, Lowenstein, Tribunal administrative de Cergy, Liberate Medical, Fischer&Paykel, Getinge, Agence Européenne Informatique, Astra, Baxter, Mindray. SE is member of American Society of Anesthesiology (Data Use Committee) and member of American Society of Anesthesiology (Perioperative Resuscitation and Life Support Committee); she is Data Safety Monitoring Board for the COVID-High Trial; she received fees from Oridion, Zoll, Medtronic, Fischer&Paykel and received equipments from Medtronic, Diasorin, Eli-Lilly, Eisai. EF received fees from Alung Technologies, Baxter, Inspira, Vasomune, Aerogen, GE. NDF is in the Advisory Board of NIH, MHRC Australia, Sedana Medical; he received funding from CIHR, received fees from Xenios. J-PF received funding from Fischer&Paykel, and received fees from Fischer&Paykel, SOS Oxygène. LG received funding from GE, Estor, and received fees from SIDAM, Grifols, Advitos, Apheretica, Estor, GE. MSH is the Committee of Canadian Critical Care Trials Group and in the Committee of Women in Critical Care of the American Thoracic Society; she received funding from Canadian Institute of Health Research and received support for travel from ESICM, ISICEM. CH leads the National ECMO Registry in Australia (EXCEL Registry) and sits in International ECMO Network Executive and Scientific Committee and is member of Research Committee for ELSO; she received funding from National Health and Medical Research Council, Medical Research Future Fund, AND received support for travel from Fischer&Paykel. CLH is in the Advisory Board of Quantum Health and received funding from National Institute of Health, American Lung Association. SJ received fees from Fischer&Paykel, Draeger Medical, Medtronic, Mindray, Baxter, Fresenius. CK is the Governmental Commission COVID-19 and Hospital Restructuring; he is in the Advisory Board of Bayer and Xenios; he received fees from Bayer, Xenios. AK received funding from Wellcome Trust, and received fees from Clinton Health Access Initiative; received equipments from Fischer&Paykel, and received support for travel from ESICM. JGL received funding from Science Foundation Ireland, Health Research Board Ireland, and received fees from Baxter. MAM received funding from National Institute of Health, Department of Defense, Roche-Genentech, and received fees from Novartis, Gilead Pharmaceuticals, Johnson and Johnson Pharmaceuticals, Cellenkos. DFMA is in the Data Safety Monitoring Board of VIr Biotechnology Inc and of Faron Pharmaceuticals; he is Co-director of Research for the Intensive Care Society and is Director of EME Program of MR-NIHR; he received funding from NIHR, Wellcome Trust, Innovate UK, MRC, Northern Ireland HSC R&D Division, Randox, Novavax, and received royalties from Queen’s University Belfast; he received fees from Bayer, GlaxoSmithKline, Boehringer Ingelhelm, Novartis, Eli-Lilly, Sobi. AM is Past- President of the Franch Society of Intensive Care; he received funding from Air Liquide Medical Systems, Fischer&Paykel, and received fees from Bayer, Air Liquide Medical Systems, Fischer&Paykel, Getinge, Covidien, Draeger Medical. NJM is in the Data Safety Monitoring Board of Caviards and NIH Spiromics and Source Studies; he received funding from National Institute of Health, Quantum Leap Health Care Collaborative, and received fees from Endpoint Health Inc, NYU Langone Medical Center, and received support for travel from Intensive Care Society. MM is in the Advisory Board of an NIH Sponsored Trial, and received funding from National Institute of Health. LM was in the Ontario COVID-19 Science Advisory Table, is in the American Thoracic Society Mechanical Ventilation Guidelines Committee and in the ESICM Guidelines Committee; she is Section Editor of Intensive Care Medicine; she received funding from Leukemia and Lymphoma Society of Canada, H Barrie Fairley Scholarship. SNM is President Elect of Indian Society of intensive Care Medicine; is Chair of Intensive Care Section of WFSA; she is member of the ESICM fluid Guidelines Committee. MNG is member of Data Safety Monitoring Board of Regeneron and EMORY; she is Chair of ATS Critical Care Assembly; she received funding from NHLBI, CDC, and received fees from New York Medical College, and received support for travel from ATS. LP is Data Safety Monitoring Board of SESAR; he received fees from Air Liquide Medical Systems, and received support for travel from Lowenstein. BKP received funding from National Institute of Health,Walder Foundation and University of Chicago and received fees from Merk, CHEST Foundation, Subpoena. AP is in Advisory Board of MEGA-ROX and UK-ROX Trails; he received funding from Novo Nordisc Foundation SYGEFORSIKRINGEN Pfizer, and received fees from Novartis. LP received fees from Lowenstein, Lungpacer, Getinge, Hamilton, Fischer&Paykel, GE, Air Liquide Medical Systems, and received support for travel from Getinge, Hamilton, Fischer&Paykel, GE, Air Liquide Medical Systems, and received equipments from Draeger Medical, Getinge. ER received funding from Wellcome Trust, and received equipments from Fischer&Paykel. ASS is Chair of Scientific Committee of ECMONet and he participated on DSMB for Gala Therapeutics; he received fees from Altimmune, Apeiron, Baxter, Cellenkos, Constant Therapeutics, Diffusion Pharmaceuticals, Edesa, Exvastat, Faron, GSK, Krypton, SafeBVM, SaNOtize, Stimit, Thornhill Scientific, and received equipments from Thornhill Scientific. RDS was member of ATS Board of directors and is member of DSMBs of RCTs in North America and received funding from National Institute of Health, and received support for travel from National Institute of Health, ATS. CS received funding from NIHR, Wellcome Trust,UK Research and Innovation and received fees from GlaxoSmithKline, Abbvie, RocheSanofi-Pasteur. TBT received funding from Department of Defense, National Heart, Lung and Blood Instituite and received fees from Bayer, Novartis, Genentech. CSVB is Scientific Director of Brazilian Association of Critical Care Medicine. JV received funding from Instituto de Salud Carlos III, Madrid, Spain (CB06/06/1088, PI19/00141), The European Regional Development Funds, and Fundación Canaria Instituto de Investigatión Sanitaria de Canarias, Spain (PIFIISC21-36). LBW is the Chair of the American Thoracic Society Awards Committee and is in the DSMB of CHILL Study and SIGNET Study; he received funding from National Institute of Health, Genentech, Boehringer Ingelheim and received fees from Santhera, Global Blood Therapeutics, Boehringer Ingelheim, Merck, Citius, Foresee Pharmaceuticals. BW is member of ESICM NEXT Committee; he received fees from Orion Pharma LTD, Dr. F. Koehler Chemie and received support for travel from Teladoc Health. FGZ received fees from Bactiguard. EA received funding from MSD, GE, Alexion, Pfizer, received fees from Pfizer, Alexion, Mindray, Sanofi and received equipments from Pfizer. The remaining Authors have disclosed that they do not have any potential conflicts of interest.

© 2023. The Author(s).

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Source: PubMed

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