Acute Respiratory Distress Syndrome

Initial assessment and management• Diagnose and treat underlying cause of ARDS• Measure patient height and calculate predicted body weight• Start oxygen therapy and ventilatory support according to disease severity

Controlled mechanical ventilation• Target tidal volume 6 ml/kg predicted body weight and Pplat ≤ 30 cm H2O• Consider higher PEEP in moderate and severe ARDS• Keep PaO2 55-80 mm Hg or SpO2 88%-95% and pH ≥ 7.25

Mild ARDSPaO2/FIO2 >200 ≤300 with PEEP or CPAP ≥ 5 cm H2O

Moderate ARDSPaO2/FIO2 >100≤200 with PEEP or CPAP ≥ 5 cm H2O

Severe ARDSPaO2/FIO2 ≤ 100 mm Hgwith PEEP ≥ 5 cm H2O

A Treatment GuideA sample treatment algorithm for adults with ARDS typically begins with optimization of lung protective ventilation, and progresses to more invasive interventions based on the condition of the patient. Treatment plans must be individualized to the cause and available interventions at the treating facility.

Is patient receiving non-invasive ventilation?

Is patient clinically stable, PaO2/FIO2>>200 mm Hg, and toleratingnon-invasive ventilation?

Consider continuingnon-invasive ventilation?

Consider current strategy and deescalate interventions when possible a�er patient improves

If patient deteriorates, reassess strategy

Yes

Yes

Is PaO2/FIO2 ≤ 150 mm Hg?

Is Pao2/FIO2 ≤ 80 mm Hg?

No

No

• Start deep sedation and prone positioning• Consider neuromuscular blocking agent and lung recruitment maneuver

Consider alternative therapies on a case-by-case basis (eg. VV ECMO, HFOV)

No

No

Yes

Yes

Patient meets Berlin definition of ARDS• Acute onset• Respiratory failure not primarily due to hydrostatic edema• Bilateral opacities on chest radiograph

JAMA. 2018;319(7):698-710. doi:10.1001/jama.2017.21907

Recognizing Pulmonary Edema is Critical1

In cases of severe ARDS associated with shock, advanced monitoring should be considered early to assist in defining a individualized therapeutic approach.

Central venous catheter

Positive response to initial therapy

Clinical assessment

Acute circulatory failure

Lactate

Associated severe ARDS?

No

Continue with same hemodynamic monitoring until shock resolution

Transpulmonary thermodilution systems

OR

Pulmonary artery catheter(especially in case of RV dysfunction)

Yes

Echocardiography Arterial catheter

Insufficient response to initial therapy

Thermodilution provides keys to identifying extravascular lung water and pulmonary vascular permeability. In clinical studies it was demonstrated that chest x-ray evaluation for pulmonary edema is very inaccurate when comparing it to the direct quantification by transpulmonary thermodilution.

Examples of chest x-rays that do not reflect the level of pulmonary edema

ELWI = 21 ml/kgSevere pulmonary edema

ELWI = 14 ml/kgModerate pulmonary edema

ELWI = 8 ml/kgNo pulmonary edema

This information is intended for an international audience outside the US and does not replace any individual therapeutic decision of the treating physician . Indications, contraindications, warnings and instructions for use are listed in the separate Instructions for Use . Products may be pending regulatory approvals to be marketed in your country . * , Getinge, and Maquet are trademarks or registered trademarks of Getinge AB, its subsidiaries or affiliates in the United States or other countries. Maquet is registered with the U.S. Patent and Trademark Office . Copyright 2018 Maquet Critical Care AB . All rights reserved . 09/18 . MPI4541EN_R00 . MX-7372 Rev01

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1 Teboul, JL., Saugel, B., Cecconi, M. et al. Intensive Care Med (2016) 42: 1350. h�ps://doi.org/10.1007/s00134-016-4375-7