ARDS has been the subject of a wide variety of randomised controlled trials, systematic reviews and meta-analyses. The ARDSNet paper of 2000 was the first to demonstrate the significant mortality benefit of low tidal volume ventilation (LTVV) and limitation of plateau airway pressures and this has now long been considered the standard of care.3
The Faculty of Intensive Care Medicine (FICM) and Intensive Care Society (ICS) Guideline Development Group has produced specific recommendations for the treatment of adults with ARDS.4 The Guidelines for the Provision of Intensive Care Services (GPICS) are in alignment with these recommendations.5
The FICM/ICS guideline contains a figure dividing ARDS management strategies according to the severity (mild, moderate or severe, as per the Berlin criteria) at which it suggests they are implemented. Patients with any degree of ARDS should be subject to LTVV and a conservative fluid strategy. Moderate ARDS should be managed with higher positive end expiratory pressure, neuromuscular blocking agents for the first 48 hours, and/or prone positioning for at least 12 hours a day. In severe ARDS, referral to a severe respiratory failure centre is recommended if certain criteria are met, for consideration of superspecialist techniques such as extracorporeal membrane oxygenation or extracorporeal carbon dioxide removal. Other treatments studied and not recommended are high-frequency oscillatory ventilation, corticosteroids and inhaled vasodilators.
