BACKGROUND This document updates previously published Clinical Practice Guidelines for the management of patients with acute respiratory distress syndrome (ARDS), incorporating new evidence addressing the use of corticosteroids, venovenous extracorporeal membrane oxygenation, neuromuscular blocking agents, and positive end-expiratory pressure (PEEP). METHODS We summarized evidence addressing four "PICO questions" (patient, intervention, comparison, and outcome). A multidisciplinary panel with expertise in ARDS used the Grading of Recommendations, Assessment, Development, and Evaluation framework to develop clinical recommendations. RESULTS We suggest the use of: 1) corticosteroids for patients with ARDS (conditional recommendation, moderate certainty of evidence), 2) venovenous extracorporeal membrane oxygenation in selected patients with severe ARDS (conditional recommendation, low certainty of evidence), 3) neuromuscular blockers in patients with early severe ARDS (conditional recommendation, low certainty of evidence), and 4) higher PEEP without lung recruitment maneuvers as opposed to lower PEEP in patients with moderate to severe ARDS (conditional recommendation, low to moderate certainty), and 5) we recommend against using prolonged lung recruitment maneuvers in patients with moderate to severe ARDS (strong recommendation, moderate certainty). CONCLUSIONS We provide updated evidence-based recommendations for the management of ARDS. Individual patient and illness characteristics should be factored into clinical decision making and implementation of these recommendations while additional evidence is generated from much-needed clinical trials.

中文翻译：

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急性呼吸窘迫综合征成年患者管理的最新进展：美国胸科学会官方临床实践指南。

背景本文件更新了之前发布的急性呼吸窘迫综合征（ARDS）患者管理的临床实践指南，纳入了关于皮质类固醇、静脉体外膜氧合、神经肌肉阻滞剂和呼气末正压（PEEP）使用的新证据。方法 我们总结了解决四个“PICO 问题”（患者、干预、比较和结果）的证据。具有 ARDS 专业知识的多学科小组使用建议分级、评估、制定和评估框架来制定临床建议。结果 我们建议使用：1) 对于 ARDS 患者使用皮质类固醇（有条件推荐，证据质量中等），2) 对选定的严重 ARDS 患者进行静脉体外膜氧合（有条件推荐，证据质量低），3) 神经肌肉阻滞剂早期严重 ARDS 患者（有条件推荐，证据质量低），4) 不进行肺复张操作的较高 PEEP，而中度至重度 ARDS 患者则较低 PEEP（有条件推荐，低至中质量证据），5)我们建议不要对中度至重度 ARDS 患者使用长时间的肺复张操作（强烈推荐，中等确定性）。结论 我们为 ARDS 的管理提供最新的循证建议。临床决策和这些建议的实施应考虑个体患者和疾病特征，同时从急需的临床试验中产生额外的证据。