Management of acute respiratory distress syndrome (ARDS)
| Management of hypoxaemia | |
| Supplemental oxygen | Intubation/mechanical ventilation (most patients) |
| Noninvasive ventilation for mild ARDS or to ↓ intubation rates (helmet better than face mask) [34] | |
| Inflammation management (corticosteroids) | Prolonged low doses (1 mg·kg−1·day−1) methylprednisolone treatment accelerates ARDS resolution and improves several clinical outcomes [39] |
| Fluid management | Aim for central venous pressure <4 mmHg or PAOP <8 mmHg to ↓ pulmonary oedema [40, 41] |
| Prone positioning [38] | |
| Decrease oxygen consumption | Antipyretics, sedatives, analgesics and paralysis agents [42] |
| Increase oxygen delivery | Inotropics to ↑ filling pressure (if no pulmonary oedema) |
| Restrict transfusions to maintain haemoglobin to 7–9 g·dL−1 [43, 44] | |
| Inhaled vasodilators (nitric oxide, prostacyclin and prostaglandin E1) to ↑ V′/Q′ matching [45] | |
| Supportive care | Sedation and analgesia [46] |
| Neuromuscular blockade if severe ARDS [47] | |
| Haemodynamic monitoring/management via CVC | |
| Nutritional support (enteral) | |
| Glucose control | |
| VAP prevention and treatment [48] | |
| DVT prophylaxis | |
| Gastrointestinal (stress ulcers) prophylaxis |
PAOP: pulmonary arterial occlusion pressure; V′/Q′: ventilation/perfusion; CVC: central venous catheter; VAP: ventilator-associated pneumonia; DVT: deep vein thrombosis.