Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2006 Dec;18(12):706-10.
In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS.
The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade.
It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve. Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended. The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS.
Evidence-based recommendations can be made regarding many aspects of the acute management of ALI/ARDS that will hopefully translate into improved outcomes for the critically ill patient. The guidelines will be updated when some important new knowledge becomes available.
2006年，中国重症医学专家起草了急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）的诊断和治疗管理指南，旨在为临床医生提供实用指导，提高全国对ALI/ARDS的认识，并改善其治疗效果。
该过程包括改良德尔菲法、共识会议、随后的几次小组和关键个人小型会议、电话会议以及小组间和整个委员会基于电子的讨论。用于分级推荐的改良德尔菲方法源自国际脓毒症论坛2001年赞助的一份出版物。对文献进行了系统综述，并将报告结果分为五个级别，以创建从A到E的推荐分级，A为最高级别。
控制ALI/ARDS的原发病至关重要。无创正压通气在ALI/ARDS中的作用尚不明确。昏迷、休克和气道清除功能受损的患者不适合使用无创正压通气。控制吸气末平台压对ARDS的管理很重要，允许性高碳酸血症可能有助于实现这一点。应考虑采用肺复张手法来打开萎陷肺并改善氧合。ARDS患者应设置最低呼气末正压（PEEP）以防止呼气末肺不张。如有可能，PEEP水平的设置可根据静态肺压力-容积曲线的测量来指导。除非有禁忌证，ARDS患者应保持半卧位。最严重的ARDS患者应考虑采用俯卧位。应使用镇静方案。不建议使用肌松剂。限制性液体管理策略对ARDS有益。不建议对ARDS患者使用皮质类固醇。其他药物在ARDS中的作用尚不确定。
关于ALI/ARDS急性管理的许多方面可以做出基于证据的推荐，有望改善重症患者的预后。当有重要的新知识可用时，将更新这些指南。
