Ventilatory and pharmacological management of acute respiratory distress syndrome (ARDS) per responsive phenotype

InterventionSuggested/recommendedResponsive phenotype
NIVRecommendedEarly phase of respiratory failure, with rapid response after start of NIV
TracheotomySuggestedProlonged mechanical ventilation
Low tidal volumesRecommendedAll patients with ARDS
Plateau pressure <30 cmH2ORecommendedAll patients with ARDS
Driving pressure <15 cmH2OSuggestedAll patients with ARDS
High PEEP strategyRecommendedPaO2/FIO2 <200
Prone positionRecommendedPaO2/FIO2 <150
Neuromuscular blocking agentsRecommendedPaO2/FIO2 <150 and first 48 h of ARDS
Extracorporeal membrane oxygenationSuggestedPatients requiring rescue therapy
GlucocorticosteroidsSuggestedNo responsive phenotype identified

NIV: noninvasive ventilation; PEEP: positive end-expiratory pressure; PaO2: arterial oxygen tension; FIO2: inspiratory oxygen fraction.