title: Clinical Practice Guideline of Acute Respiratory Distress Syndrome.
abstract: There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.
authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors: Young-Jae
authors: YJ
authors: Cho
authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
authors: Jae Young
authors: JY
authors: Moon
authors: Research Agency for Clinical Practice Guidelines, Korean Academy of Medical Sciences Research Center, Seoul, Korea.
authors: Ein-Soon
authors: ES
authors: Shin
authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
authors: Je Hyeong
authors: JH
authors: Kim
authors: Department of Pulmonary and Critical Care Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors: Hoon
authors: H
authors: Jung
authors: Department of Pulmonary and Critical Care Medicine, Kyung Hee University Medical Center, Seoul, Korea.
authors: So Young
authors: SY
authors: Park
authors: Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea.
authors: Ho Cheol
authors: HC
authors: Kim
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
authors: Yun Su
authors: YS
authors: Sim
authors: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors: Chin Kook
authors: CK
authors: Rhee
authors: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors: Jaemin
authors: J
authors: Lim
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors: Seok Jeong
authors: SJ
authors: Lee
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors: Won-Yeon
authors: WY
authors: Lee
authors: Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors: Hyun Jeong
authors: HJ
authors: Lee
authors: Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors: Sang Hyun
authors: SH
authors: Kwak
authors: Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea.
authors: Eun Kyeong
authors: EK
authors: Kang
authors: Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
authors: Kyung Soo
authors: KS
authors: Chung
authors: Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea.
authors: Won-Il
authors: WI
authors: Choi
keywords: Practice Guideline; Respiration, Artificial; Respiratory Distress Syndrome, Acute; Respiratory Distress Syndrome, Adult; Ventilators, Mechanical