Tasaka Sadatomo, Ohshimo Shinichiro, Takeuchi Muneyuki, Yasuda Hideto, Ichikado Kazuya, Tsushima Kenji, Egi Moritoki, Hashimoto Satoru, Shime Nobuaki, Saito Osamu, Matsumoto Shotaro, Nango Eishu, Okada Yohei, Hayashi Kenichiro, Sakuraya Masaaki, Nakajima Mikio, Okamori Satoshi, Miura Shinya, Fukuda Tatsuma, Ishihara Tadashi, Kamo Tetsuro, Yatabe Tomoaki, Norisue Yasuhiro, Aoki Yoshitaka, Iizuka Yusuke, Kondo Yutaka, Narita Chihiro, Kawakami Daisuke, Okano Hiromu, Takeshita Jun, Anan Keisuke, Okazaki Satoru Robert, Taito Shunsuke, Hayashi Takuya, Mayumi Takuya, Terayama Takero, Kubota Yoshifumi, Abe Yoshinobu, Iwasaki Yudai, Kishihara Yuki, Kataoka Jun, Nishimura Tetsuro, Yonekura Hiroshi, Ando Koichi, Yoshida Takuo, Masuyama Tomoyuki, Sanui Masamitsu
Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan.
Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Intensive Care. 2022 Jul 8;10(1):32. doi: 10.1186/s40560-022-00615-6.
The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021.
The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method.
Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4-8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO (PaO) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D), we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D), we suggest against routinely implementing NO inhalation therapy (GRADE 2C), and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D).
This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jsicm.org/publication/guideline.html ). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.
日本重症医学学会/日本呼吸学会/日本呼吸护理医学会急性呼吸窘迫综合征临床实践指南联合委员会制定并发布了《2021年急性呼吸窘迫综合征临床实践指南》。
2016年版临床实践指南涵盖的临床问题（CQs）仅针对成人，但本指南除了46个成人CQs外，还包括15个儿童CQs。与上一版一样，我们采用了推荐分级评估、制定与评价（GRADE）系统的系统评价方法以及推荐程度确定方法。我们还进行了系统评价，采用诊断准确性的Meta分析和网络Meta分析作为新方法。
描述了针对成人急性呼吸窘迫综合征患者的推荐意见：我们建议不要使用血清C反应蛋白和降钙素原水平来识别潜在疾病细菌性肺炎（GRADE 2D）；我们建议机械通气时将潮气量限制在4-8 mL/kg（GRADE 1D）；我们建议不要针对过低的SpO（PaO）进行管理（GRADE 2D）；我们建议不要在呼气末正压设置中常规使用跨肺压（GRADE 2B）；我们建议对重症急性呼吸窘迫综合征患者实施体外膜肺氧合（GRADE 2B）；我们建议不要使用大剂量类固醇（GRADE 2C）；我们建议使用小剂量类固醇（GRADE 1B）。针对儿童急性呼吸窘迫综合征患者的推荐意见如下：我们建议不要使用无创呼吸支持（无创正压通气/高流量鼻导管给氧治疗）（GRADE 2D），我们建议将中度急性呼吸窘迫综合征的儿童患者置于俯卧位（GRADE 2D），我们建议不要常规实施一氧化氮吸入治疗（GRADE 2C），我们建议不要对呼吸衰竭的儿童患者实施每日镇静中断（GRADE 2D）。
本文是日文版《2021年急性呼吸窘迫综合征临床实践指南》完整版的翻译摘要（网址：https://www.jsicm.org/publication/guideline.html ）。原文是为日本医疗专业人员撰写的，可能包含与其他国家医疗专业人员不同的观点。
