Maryland Critical Care Network

Clinical Practice Guideline for the Management of Acute Respiratory Distress Syndrome (ARDS)

Syndrome consistent with ARDS?

- Acute onset (< 1 week)
- No evidence of isolated left heart failure (ECHO)
Berlin Criteria for ARDS Diagnosis and Staging
- Bilateral opacities on chest radiograph

YES

Gas exchange goals met?

PaO2/FiO2 > 200
SpO2/FiO2 > 235
pH > 7.25

YES NO
ARDS Definition Task Force. JAMA 2012.

- Diagnose and treat underlying cause for ARDS

- Consider non-invasive positive pressure - Avoid volutrauma (tidal volume 6 mc/kg/PBW)
ventilation - Avoid barotrauma (goal PPlt < 30 cm H2O)
- Consider high flow nasal cannula - Avoid atelectais Moderate -
- Treat the underlying condition (titrate PEEP according to ARDSnet tables) Severe ARDS
Mild - Optimize oxygenation
ARDS (PaO2 goal: 55- 80 mm Hg or SpO2 > 88-96 %)
- Optimize ventilation (pH > 7.25)
Improved respiratory dynamics? Continue
Clinically stable? Achieving goals?
NO PaO2/FiO2 > 150 YES Current
PaO2/FiO2 > 200 or SpO2 / FiO2 > 235? Therapy
pH > 7.25

- Start deep sedation AND

Severe
YES NO - Prone positioning (refer to institutional protocol)
ARDS
- Consider neuromuscular blockade (max 48 hrs)

Continue
Current Achieving goals? Continue
NO PaO2/FiO2 > 80 YES Current
Therapy
pH > 7.25 Therapy

UMMC/STC consultation for transfer

- Extracoropreal membrane oxygenation (ECMO)
- Advanced lung rescue techniques

Consider consultation for transfer to UMMC if unable to implement proning,

neuromuscular blockade, etc. or if the patient continues to deteriorate

17 January 2019
J. Lantry / S. Galvagno
Adapted from Fan EF et al.
JAMA 2018; 319 (7).
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