Journal of Intensive Care (Jul 2022)

ARDS Clinical Practice Guideline 2021

  • Sadatomo Tasaka,
  • Shinichiro Ohshimo,
  • Muneyuki Takeuchi,
  • Hideto Yasuda,
  • Kazuya Ichikado,
  • Kenji Tsushima,
  • Moritoki Egi,
  • Satoru Hashimoto,
  • Nobuaki Shime,
  • Osamu Saito,
  • Shotaro Matsumoto,
  • Eishu Nango,
  • Yohei Okada,
  • Kenichiro Hayashi,
  • Masaaki Sakuraya,
  • Mikio Nakajima,
  • Satoshi Okamori,
  • Shinya Miura,
  • Tatsuma Fukuda,
  • Tadashi Ishihara,
  • Tetsuro Kamo,
  • Tomoaki Yatabe,
  • Yasuhiro Norisue,
  • Yoshitaka Aoki,
  • Yusuke Iizuka,
  • Yutaka Kondo,
  • Chihiro Narita,
  • Daisuke Kawakami,
  • Hiromu Okano,
  • Jun Takeshita,
  • Keisuke Anan,
  • Satoru Robert Okazaki,
  • Shunsuke Taito,
  • Takuya Hayashi,
  • Takuya Mayumi,
  • Takero Terayama,
  • Yoshifumi Kubota,
  • Yoshinobu Abe,
  • Yudai Iwasaki,
  • Yuki Kishihara,
  • Jun Kataoka,
  • Tetsuro Nishimura,
  • Hiroshi Yonekura,
  • Koichi Ando,
  • Takuo Yoshida,
  • Tomoyuki Masuyama,
  • Masamitsu Sanui,
  • ARDS Clinical Practice Guideline 2021 committee from the Japanese Society of Intensive Care Medicine, the Japanese Respiratory Society, and the Japanese Society of Respiratory Care Medicine

DOI
https://doi.org/10.1186/s40560-022-00615-6
Journal volume & issue
Vol. 10, no. 1
pp. 1 – 52

Abstract

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Abstract Background The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021. Methods The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method. Results Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4–8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO2 (PaO2) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D), we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D), we suggest against routinely implementing NO inhalation therapy (GRADE 2C), and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D). Conclusions This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jsicm.org/publication/guideline.html ). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.

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