日本版ARDS管理臨床実践ガイドライン

The clinical practice guideline for the management of ARDS in Japan
Satoru Hashimoto, et al. and ARDS clinical practice guideline committee from the Japanese Society of Respiratory Care Medicine and the Japanese Society of Intensive Care Medicine
J Intensive Care. 2017; 5: 50.
Published online 2017 Jul 25.
doi:  10.1186/s40560-017-0222-3
PMCID: PMC5526253

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526253/


The recommendations for adult patients with ARDS include:

• we suggest against early tracheostomy (GRADE 2C),
• we suggest using NPPV for early respiratory management (GRADE 2C),
• we recommend the use of low tidal volumes at 6-8 mL/kg (GRADE 1B),
• we suggest setting the plateau pressure at 30cmH20 or less (GRADE2B),
• we suggest using PEEP within the range of plateau pressures less than or equal to 30cmH2O, without compromising hemodynamics (Grade 2B), and using higher PEEP levels in patients with moderate to severe ARDS (Grade 2B),
• we suggest using protocolized methods for liberation from mechanical ventilation (Grade 2D), 
• we suggest prone positioning especially in patients with moderate to severe respiratory dysfunction (GRADE 2C),
• we suggest against the use of high frequency oscillation (GRADE 2C), 
• we suggest the use of neuromuscular blocking agents in patients requiring mechanical ventilation under certain circumstances (GRADE 2B),
• we suggest fluid restriction in the management of ARDS (GRADE 2A),
• we do not suggest the use of neutrophil elastase inhibitors (GRADE 2D),
• we suggest the administration of steroids, equivalent to methylprednisolone 1-2mg/kg/ day (GRADE 2A), and
• we do not recommend other medications for the treatment of adult patients with ARDS (GRADE1B; inhaled/intravenous β2 stimulants, prostaglandin E1, activated protein C, ketoconazole, and lisofylline, GRADE 1C; inhaled nitric oxide, GRADE 1D; surfactant, GRADE 2B; granulocyte macrophage colony-stimulating factor, N-acetylcysteine, GRADE 2C; Statin.)