title: Scandinavian clinical practice guideline on fluid and drug therapy in adults with acute respiratory distress syndrome.
abstract: The objective of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) task force on fluid and drug therapy in adults with acute respiratory distress syndrome (ARDS) was to provide clinically relevant, evidence-based treatment recommendations according to standards for trustworthy guidelines.
  
  
  
  The guideline was developed according to standards for trustworthy guidelines, including a systematic review of the literature and use of the GRADE methodology for assessment of the quality of evidence and for moving from evidence to recommendations.
  
  
  
  A total of seven ARDS interventions were assessed. We suggest fluid restriction in patients with ARDS (weak recommendation, moderate quality evidence). Also, we suggest early use of neuromuscular blocking agents (NMBAs) in patients with severe ARDS (weak recommendation, moderate quality evidence). We recommend against the routine use of other drugs, including corticosteroids, beta2 agonists, statins, and inhaled nitric oxide (iNO) or prostanoids in adults with ARDS (strong recommendations: low- to high-quality evidence). These recommendations do not preclude the use of any drug or combination of drugs targeting underlying or co-existing disorders.
  
  
  
  This guideline emphasizes the paucity of evidence of benefit - and potential for harm - of common interventions in adults with ARDS and highlights the need for prudence when considering use of non-licensed interventions in this patient population.
authors.affiliation: Anaesthesiology and Intensive Care Medicine, Umeå University and the University Hospital of Umeå, Umeå, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Claesson
authors.affiliation: Anaesthesiology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Freundlich
authors.affiliation: Anaesthesiology and Intensive Care Medicine, Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: I
authors.initials: I
authors.lastname: Gunnarsson
authors.affiliation: Anaesthesiology, Division of Critical Care, Oslo University Hospital, Oslo, Norway.
authors.forename: J H
authors.initials: JH
authors.lastname: Laake
authors.affiliation: Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: M H
authors.identifier: 0000-0002-6378-9673
authors.initials: MH
authors.lastname: Møller
authors.affiliation: Medicine, Innlandet Hospital Trust-Division Gjøvik, Norway and Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: P O
authors.initials: PO
authors.lastname: Vandvik
authors.affiliation: Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Varpula
authors.affiliation: Anaesthesiology, Division of Critical Care, Oslo University Hospital, Oslo, Norway.
authors.forename: T A
authors.initials: TA
authors.lastname: Aasmundstad
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D003422:Critical Care; D005440:Fluid Therapy; D006801:Humans; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D009466:Neuromuscular Blocking Agents