From: Biomarkers for Acute Respiratory Distress syndrome and prospects for personalised medicine
Supportive therapy | Comment |
---|---|
Lung protective ventilation with low tidal volume (4–8 ml/kg predicted body weight) and low inspiratory pressures (plateau pressure < 30 cmH2O) | Strong recommendation [75] |
Higher level of PEEP§ in patients with moderate or severe ARDS | Conditional recommendation [75] |
Lung recruitment maneuvers in patients with moderate or severe ARDS | Conditional recommendation [75] |
Prone positioning for more than 12 h/die in patients with severe ARDS | Strong recommendation [75] |
HFOV | Strong recommendation against the routine use of HFOV [75] |
ECMO | Rescue therapy for refractory hypoxemia in severe ARDS. No recommendation is made, additional studies are needed [75]. |
Conservative fluid management strategy | It shortened the duration of assisted ventilation in large randomized trial [94, 95] |
Pharmacological therapy | |
Glucocorticoids | Inconclusive results on doses and duration of treatment. May provide some benefit on oxygenation, reduce inflammatory process and ventilation days. They are harmful if started 14 days after ARDS diagnosis [96]. |
Inhaled nitric oxide (NO) | Improves transiently oxygenation. Does not affect mortality. Higher grade of AKI [80]. |
Neuromuscolar blockade | Improve outcomes in patients with moderate to-severe ARDS, ensures patient–ventilator synchrony and reduces the risk of VILI [81]. Higher risk of diaphragm atrophy and ICU acquired weakness. Ongoing trial (NCT02509078). |
Mesenchimal stem cells | Phase 2a clinical trials to establish safety in ARDS are in progress and two phase 1 trials did not report any serious adverse events [81]. |