Recommendations
➤ The ATS, ESICM, and SCCM recommend that adult patients
with ARDS receive mechanical ventilation with strategies
that limit tidal volumes (4–8 ml/kg predicted body weight –
PBW) and inspiratory pressures (plateau pressure <30 cm
H
2
O) (Strong recommendation, moderate confidence in effect
estimates).
➤ The ATS, ESICM, and SCCM recommend that adult patients
with severe ARDS receive prone positioning for >12 hours per
day. (Strong recommendation, moderate-high confidence in
effect estimates)
➤ The ATS, ESICM, and SCCM recommend that high-frequency
oscillatory (HFOV) NOT be used routinely in patients
with moderate or severe ARDS. (Strong recommendation,
moderate-high confidence in effect estimates)
➤ The ATS, ESICM, and SCCM suggest that adult patients
with moderate or severe ARDS receive higher rather than
lower levels of positive end-expiratory pressure (PEEP).
(Conditional recommendation, moderate confidence in effect
estimates)
➤ The ATS, ESICM, and SCCM suggest that adult patients with
moderate or severe ARDS receive recruitment maneuvers
(RMs). (Conditional recommendation, low-moderate
confidence in the effect estimates)
➤ Additional evidence is necessary to make a definitive
recommendation for or against the use of extracorporeal
membrane oxygenation (ECMO) in patients with severe
ARDS. In the interim, the ATS, ESICM, and SCCM recommend
ongoing research measuring clinical outcomes among
patients with severe ARDS who undergo ECMO.
