Update on management of acute respiratory distress syndrome

Abstract

Acute respiratory distress syndrome (ARDS) is a frequent and life-threatening condition in intensive care units (ICUs). Management of ARDS remains challenging despite years of research. Morbidity and mortality are not only caused by the syndrome itself but can also be the result of ventilator-induced lung injury. In this article, an update on ARDS management including ventilator strategies, rescue therapies, pharmacological treatments, ICU supportive care, and rehabilitation is proposed. While lung protective ventilation remains the standard option for patients with ARDS, neuromuscular blockade and prone positioning are gaining support after successful trials. Helmet non-invasive ventilation and high-flow nasal cannula might be useful for mild-to-moderate ARDS. Extracorporeal membrane oxygenation and carbon dioxide removal are not recommended in standard practice although they might be useful in severe ARDS.

Keywords

• acute respiratory distress syndrome
• respiratory failure
• lung protective strategies
• mechanical ventilation
• ECMO
• prone ventilation
• neuromuscular blockade
• high flow nasal cannula