Management of acute respiratory distress syndrome (ARDS)

Management of hypoxaemia
 Supplemental oxygenIntubation/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 managementAim for central venous pressure <4 mmHg or PAOP <8 mmHg to ↓ pulmonary oedema [40, 41]
 Prone positioning [38]
 Decrease oxygen consumptionAntipyretics, sedatives, analgesics and paralysis agents [42]
 Increase oxygen deliveryInotropics 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 careSedation 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.