Author/Authors :
Cho, Young-Jae Department of Internal Medicine - Seoul National University College of Medicine - Seoul National University Bundang Hospital, Seongnam , Moon, Jae Young Department of Internal Medicine - Chungnam National University Hospital, Daejeon , Shin, Ein-Soon Korean Academy of Medical Sciences Research Center, Seoul , Kim, Je Hyeong Department of Internal Medicine - Korea University Ansan Hospital - Ansan - Korea University College of Medicine , Jung, Hoon Department of Pulmonary and Critical Care Medicine - Inje University Ilsan Paik Hospital, Goyang , Park, So Young Department of Pulmonary and Critical Care Medicine - Kyung Hee University Medical Center, Seoul , Kim, Ho Cheol Department of Internal Medicine - Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon , Sim, Yun Su Department of Internal Medicine - Hallym University Kangnam Sacred Heart Hospital, Seoul , Rhee, Chin Kook Department of Medicine - Seoul St. Mary’s Hospital - Catholic University of Korea, Seoul , Lim, Jaemin Department of Medicine - Gangneung Asan Hospital - University of Ulsan Medical College of Medicine, Gangneung , Lee, Seok Jeong Department of Internal Medicine - Yonsei University Wonju College of Medicine, Wonju , Lee, Won-Yeon Department of Internal Medicine - Yonsei University Wonju College of Medicine, Wonju , Lee, Hyun Jeong Department of Anesthesiology and Pain Medicine - Chonnam National University Medical School and Hospital, Gwangju , Kwak, Sang Hyun Department of Anesthesiology and Pain Medicine - Chonnam National University Medical School and Hospital, Gwangju , Kang, Eun Kyeong Department of Pediatrics - Dongguk University Ilsan Hospital, Goyang , Chung, Kyung Soo Department of Internal Medicine - Severance Hospital - Institute of Chest Diseases - Yonsei University College of Medicine, Seoul , Choi, Won-Il Department of Internal Medicine - Keimyung University Dongsan Hospital - Daegu, Korea
Abstract :
There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome
(ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the
quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide
(1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation
as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically
ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective
ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the
management of ARDS, and three for mechanically ventilated patients.
Keywords :
practice guideline , respiration , artificial , respiratory distress syndrome , acute , respiratory distress syndrome , mechanical
