The clinical practice guideline for the management of ARDS in Japan

被引：52

作者：

Hashimoto, Satoru ^{[1
]}

Sanui, Masamitsu ^{[2
]}

Egi, Moritoki ^{[3
]}

Ohshimo, Shinichiro ^{[4
]}

Shiotsuka, Junji ^{[5
]}

Seo, Ryutaro ^{[6
]}

Tanaka, Ryoma ^{[7
]}

Tanaka, Yu ^{[8
]}

Norisue, Yasuhiro ^{[9
]}

Hayashi, Yoshiro ^{[10
]}

Nango, Eishu ^{[11
]}

机构：

[1] Kyoto Prefectural Univ Med, Dept Anesthesiol & Intens Care, Kyoto, Japan

[2] Jichi Med Univ, Dept Anesthesiol & Crit Care Med, Saitama Med Ctr, Saitama, Japan

[3] Kobe Univ Hosp, Dept Anesthesiol, Kobe, Hyogo, Japan

[4] Hiroshima Univ, Dept Emergency & Crit Care Med, Hiroshima, Japan

[5] Okinawa Chubu Hosp, Div Crit Care Med, Okinawa, Japan

[6] Kobe City Med Ctr, Dept Emergency Med, Gen Hosp, Kobe, Hyogo, Japan

[7] LDS Hosp, Pulm & Crit Care Med, Salt Lake City, UT USA

[8] Nara Med Univ, Dept Anesthesiol, Nara, Japan

[9] Tokyo Bay Med Ctr, Dept Emergency & Crit Care Med, Tokyo, Japan

[10] Kameda Med Ctr, Dept Intens Care Med, Chiba, Japan

[11] Tokyo Kita Social Insurance Hosp, Dept Gen Med, Tokyo, Japan

来源：

JOURNAL OF INTENSIVE CARE | 2017年 / 5卷

关键词：

ARDS; Acute lung injury; systematic review; clinical practice guideline; RESPIRATORY-DISTRESS-SYNDROME; ACUTE LUNG INJURY; POSITIVE-PRESSURE VENTILATION; INHALED NITRIC-OXIDE; END-EXPIRATORY PRESSURE; CRITICALLY-ILL PATIENTS; CONVENTIONAL MECHANICAL VENTILATION; ACTIVATED PROTEIN-C; PROLONGED ENDOTRACHEAL INTUBATION; FREQUENCY OSCILLATORY VENTILATION;

D O I：

10.1186/s40560-017-0222-3

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: The Japanese Society of Respiratory Care Medicine and the Japanese Society of Intensive Care Medicine provide here a clinical practice guideline for the management of adult patients with ARDS in the ICU. Method: The guideline was developed applying the GRADE system for performing robust systematic reviews with plausible recommendations. The guideline consists of 13 clinical questions mainly regarding ventilator settings and drug therapies (the last question includes 11 medications that are not approved for clinical use in Japan). Results: 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 30cmH(2)0 or less (GRADE2B), we suggest using PEEP within the range of plateau pressures less than or equal to 30cmH(2)O, 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 beta 2 stimulants, prostaglandin E-1, 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.) Conclusions: This article was translated from the Japanese version originally published as the ARDS clinical practice guidelines 2016 by the committee of ARDS clinical practice guideline (Tokyo, 2016, 293p, available from http://www.jsicm.org/ARDSGL/ARDSGL2016. pdf). The original article, written for Japanese healthcare providers, provides points of view that are different from those in other countries.

引用

页数：32

共 208 条

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