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급성호흡곤란증후군의 최신 진료 지침

Updated Guidelines for Acute Respiratory Distress Syndrome

김태완|김원영
대한내과학회 (The Korean Association Of Internal Medicine)|2023.10|대한내과학회지 (The Korean Journal of Medicine)|제98권 제5호|pp. 212-222|DOI https://doi.org/10.3904/kjm.2023.98.5.212

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키워드

Guideline진료 지침Respiratory distress syndromeRespiratory insufficiency급성호흡곤란증후군급성저산소혈증호흡부전
주제분류내과학

초록

Acute respiratory distress syndrome (ARDS) accounts for 10% of patients admitted to the intensive care unit and 23% of patients using mechanical ventilation, with a mortality rate of 45% in severe cases. The perception that patients with ARDS are vulnerable to ventilator-induced lung injury has led to lung-protective ventilation strategies. Accordingly, the American Thoracic Society, the European Society of Intensive Care Medicine (ESICM), and the Society of Critical Care Medicine announced ARDS mechanical ventilation guidelines in 2017. Since then, based on the results of newly reported research and data accumulated throughout the coronavirus disease 2019 pandemic, the ESICM announced an amendment to the previous guidelines in 2023. The revised ARDS guidelines discuss extending the ARDS definition and its phenotypes that were not mentioned in the previous guidelines. The new guidelines encompass ventilation strategies, including positive end-expiratory pressure and recruitment maneuvers in patients receiving mechanical ventilation. In addition, various oxygenation devices, such as high-flow nasal cannulated oxygen and continuous positive airway pressure in nonmechanically ventilated patients, are introduced. This review discusses new changes in the diagnosis and treatment of ARDS based on the new ESICM guidelines, providing a supportive background and rationale.

Abstract

Acute respiratory distress syndrome (ARDS) accounts for 10% of patients admitted to the intensive care unit and 23% of patients using mechanical ventilation, with a mortality rate of 45% in severe cases. The perception that patients with ARDS are vulnerable to ventilator-induced lung injury has led to lung-protective ventilation strategies. Accordingly, the American Thoracic Society, the European Society of Intensive Care Medicine (ESICM), and the Society of Critical Care Medicine announced ARDS mechanical ventilation guidelines in 2017. Since then, based on the results of newly reported research and data accumulated throughout the coronavirus disease 2019 pandemic, the ESICM announced an amendment to the previous guidelines in 2023. The revised ARDS guidelines discuss extending the ARDS definition and its phenotypes that were not mentioned in the previous guidelines. The new guidelines encompass ventilation strategies, including positive end-expiratory pressure and recruitment maneuvers in patients receiving mechanical ventilation. In addition, various oxygenation devices, such as high-flow nasal cannulated oxygen and continuous positive airway pressure in nonmechanically ventilated patients, are introduced. This review discusses new changes in the diagnosis and treatment of ARDS based on the new ESICM guidelines, providing a supportive background and rationale.

참고문헌 (73)

  1. Ferguson ND, "The Berlin definition of ARDS : an expanded rationale, justification, and supplementary material", Intensive Care Med, 38, pp.1573~1582 (2012)
  2. Bellani G, "Incidence of acute respiratory distress syndrome--reply", JAMA, 316, pp.347~ (2016)
  3. Tonetti T, "Driving pressure and mechanical power : new targets for VILI prevention", Ann Transl Med, 5, pp.286~ (2017)
  4. Gattinoni L, "Stress and strain within the lung", Curr Opin Crit Care, 18, pp.42~47 (2012)
  5. Fan E, "An official American Thoracic Society", European Society of Intensive Care Medicine, Am J Respir Crit Care Med, pp.2017, 195[DOI]
  6. ARDS Definition Task Force, "Acute respiratory distress syndrome : the Berlin definition", JAMA, 307, pp.2526~2533 (2012)
  7. Matthay MA, "The Berlin definition of acute respiratory distress syndrome : should patients receiving high-flow nasal oxygen be included?", Lancet Respir Med, 9, pp.933~936 (2021)
  8. Ranieri VM, "High-flow nasal oxygen for severe hypoxemia : oxygenation response and outcome in patients with COVID-19", Am J Respir Crit Care Med, 205, pp.431~439 (2022)
  9. Rice TW, "Comparison of the SpO2", FIO2 ratio and the PaO2, Chest, pp.2007, 132[DOI]
  10. Brown SM, "Nonlinear imputation of PaO2", FiO2 from SpO2, Chest, pp.2016, 150[DOI]
  11. Wick KD, "Pulse oximetry for the diagnosis and management of acute respiratory distress syndrome", Lancet Respir Med, 10, pp.1086~1098 (2022)
  12. Goddard SL, "The randomized educational acute respiratory distress syndrome diagnosis study : a trial to improve the radiographic diagnosis of acute respiratory distress syndrome", Crit Care Med, 46, pp.743~748 (2018)
  13. Khemani RG, "Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus Conference", Pediatr Crit Care Med, 16(Suppl 1), pp.S23~S40 (2015)
  14. Schenck EJ, "Rapidly improving ARDS in therapeutic randomized controlled trials", Chest, 155, pp.474~482 (2019)
  15. Constantin JM, "Personalised mechanical ventilation tailored to lung morphology versus low positive end-expiratory pressure for patients with acute respiratory distress syndrome in France(the LIVE study) : a multicentre, single-blind, randomised controlled trial", Lancet Respir Med, 7, pp.870~880 (2019)
  16. Frat JP, "High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure", N Engl J Med, 372, pp.2185~2196 (2015)
  17. Parke R, "Nasal high-flow therapy delivers low level positive airway pressure", Br J Anaesth, 103, pp.886~890 (2009)
  18. Mendil NA, "The use of high-flow nasal oxygen vs. standard oxygen therapy in hematological malignancy patients with acute respiratory failure in hematology wards", Turk J Med Sci, 51, pp.1756~1763 (2021)
  19. Ospina-Tascón GA, "Effect of high-flow oxygen therapy vs conventional oxygen therapy on invasive mechanical ventilation and clinical recovery in patients with severe COVID-19 : a randomized clinical trial", JAMA, 326, pp.2161~2171 (2021)
  20. Azoulay E, "Effect of high-flow nasal oxygen vs standard oxygen on 28-day mortality in immunocompromised patients with acute respiratory failure : the HIGH randomized clinical trial", JAMA, 320, pp.2099~2107 (2018)
  21. Perkins GD, "Effect of noninvasive respiratory strategies on intubation or mortality among patients with acute hypoxemic respiratory failure and COVID-19 : the RECOVERY-RS randomized clinical trial", JAMA, 327, pp.546~558 (2022)
  22. Rochwerg B, "Official ERS", ATS clinical practice guidelines : noninvasive ventilation for acute respiratory failure, 2017, pp.50, 1602426~
  23. Wang D, "Clinical characteristics of 138hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China", JAMA, 323, pp.1061~1069 (2020)
  24. Alhazzani W, "Surviving Sepsis Campaign : guidelines on the management of critically ill adults with coronavirus disease 2019(COVID-19)", Intensive Care Med, 46, pp.854~887 (2020)
  25. Coudroy R, "High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure : a randomised controlled trial", Lancet Respir Med, 10, pp.641~649 (2022)
  26. Grieco DL, "Effect of helmet noninvasive ventilation vs high-flow nasal oxygen on days free of respiratory support in patients with COVID-19 and moderate to severe hypoxemic respiratory failure : the HENIVOT randomized clinical trial", JAMA, 325, pp.1731~1743 (2021)
  27. Nair PR, "Comparison of high-flow nasal cannula and noninvasive ventilation in acute hypoxemic respiratory failure due to severe COVID-19 pneumonia", Respir Care, 66, pp.1824~1830 (2021)
  28. Munshi L, "Noninvasive respiratory support for adults with acute respiratory failure", N Engl J Med, 387, pp.1688~1698 (2022)
  29. Brochard L, "Mechanical ventilation to minimize progression of lung injury in acute respiratory failure", Am J Respir Crit Care Med, 195, pp.438~442 (2017)
  30. He H, "A multicenter RCT of noninvasive ventilation in pneumonia-induced early mild acute respiratory distress syndrome", Crit Care, 23, pp.300~ (2019)
  31. Lemiale V, "Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure : a randomized clinical trial", JAMA, 314, pp.1711~1719 (2015)
  32. Brambilla AM, "Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia", Intensive Care Med, 40, pp.942~949 (2014)
  33. Antonelli M, "Noninvasive positive pressure ventilation using a helmet in patients with acute exacerbation of chronic obstructive pulmonary disease : a feasibility study", Anesthesiology, 100, pp.16~24 (2004)
  34. Antonelli M, "New treatment of acute hypoxemic respiratory failure : noninvasive pressure support ventilation delivered by helmet--a pilot controlled trial", Crit Care Med, 30, pp.602~608 (2002)
  35. Patel BK, "Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome : a randomized clinical trial", JAMA, 315, pp.2435~2441 (2016)
  36. Acute Respiratory Distress Syndrome Network, "Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome", N Engl J Med, 342, pp.1301~1308 (2000)
  37. Stewart TE, "Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure-and Volume-Limited Ventilation Strategy Group", N Engl J Med, 338, pp.355~361 (1998)
  38. Brochard L, "Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on tidal volume reduction in ARDS", Am J Respir Crit Care Med, 158, pp.1831~1888 (1998)
  39. Reddy MP, "Respiratory system mechanics, gas exchange, and outcomes in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome : a systematic review and meta-analysis", Lancet Respir Med, 10, pp.1178~1188 (2022)
  40. Matthay MA, "Acute respiratory distress syndrome", Nat Rev Dis Primers, 5, pp.18~ (2019)
  41. Mertens M, "Alveolar dynamics in acute lung injury : heterogeneous distension rather than cyclic opening and collapse", Crit Care Med, 37, pp.2604~2611 (2009)
  42. Cressoni M, "Lung inhomogeneity in patients with acute respiratory distress syndrome", Am J Respir Crit Care Med, 189, pp.149~158 (2014)
  43. Brower RG, "Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome", N Engl J Med, 351, pp.327~336 (2004)
  44. Meade MO, "Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome : a randomized controlled trial", JAMA, 299, pp.637~645 (2008)
  45. Mercat A, "Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome : a randomized controlled trial", JAMA, 299, pp.646~655 (2008)
  46. Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial(ART)Investigators, "Effect of lung recruitment and titrated positive end-expiratory pressure(PEEP)vs low PEEP on mortality in patients with acute respiratory distress syndrome : a randomized clinical trial", JAMA, 318, pp.1335~1345 (2017)
  47. Pintado MC, "Individualized PEEP setting in subjects with ARDS : a randomized controlled pilot study", Respir Care, 58, pp.1416~1423 (2013)
  48. Beitler JR, "Effect of titrating positive end-expiratory pressure(PEEP)with an esophageal pressure-guided strategy vs an empirical high PEEP-FiO2 strategy on death and days free from mechanical ventilation among patients with acute respiratory distress syndrome : a randomized clinical trial", JAMA, 321, pp.846~857 (2019)
  49. Talmor D, "Mechanical ventilation guided by esophageal pressure in acute lung injury", N Engl J Med, 359, pp.2095~2104 (2008)
  50. Dianti J, "Association of positive end-expiratory pressure and lung recruitment selection strategies with mortality in acute respiratory distress syndrome : a systematic review and network meta-analysis", Am J Respir Crit Care Med, 205, pp.1300~1310 (2022)
  51. Briel M, "Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome : systematic review and meta-analysis", JAMA, 303, pp.865~873 (2010)
  52. Brower RG, "Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure", Crit Care Med, 31, pp.2592~2597 (2003)
  53. Chung FT, "Alveolar recruitment maneuver attenuates extravascular lung water in acute respiratory distress syndrome", Medicine(Baltimore), 96, pp.e7627~ (2017)
  54. Kung SC, "Effects of stepwise lung recruitment maneuvers in patients with early acute respiratory distress syndrome : a prospective, randomized, controlled trial", J Clin Med, 8, pp.231~ (2019)
  55. Hodgson CL, "Maximal recruitment open lung ventilation in acute respiratory distress syndrome(PHARLAP). A phase II, multicenter randomized controlled clinical trial", Am J Respir Crit Care Med, 200, pp.1363~1372 (2019)
  56. Hodgson CL, "A randomised controlled trial of an open lung strategy with staircase recruitment, titrated PEEP and targeted low airway pressures in patients with acute respiratory distress syndrome", Crit Care, 15, pp.R133~ (2011)
  57. Xi XM, "Clinical efficacy and safety of recruitment maneuver in patients with acute respiratory distress syndrome using low tidal volume ventilation : a multicenter randomized controlled clinical trial", Chin Med J(Engl), 123, pp.3100~3105 (2010)
  58. Kacmarek RM, "Open lung approach for the acute respiratory distress syndrome : a pilot, randomized controlled trial", Crit Care Med, 44, pp.32~42 (2016)
  59. Guérin C, "Prone positioning in severe acute respiratory distress syndrome", N Engl J Med, 368, pp.2159~2168 (2013)
  60. Weatherald J, "Efficacy of awake prone positioning in patients with covid-19 related hypoxemic respiratory failure : systematic review and meta-analysis of randomized trials", BMJ, 379, pp.e071966~ (2022)
  61. Alhazzani W, "Effect of awake prone positioning on endotracheal intubation in patients with COVID-19 and acute respiratory failure : a randomized clinical trial", JAMA, 327, pp.2104~2113 (2022)
  62. Rosén J, "Awake prone positioning in patients with hypoxemic respiratory failure due to COVID-19 : the PROFLO multicenter randomized clinical trial", Crit Care, 25, pp.209~ (2021)
  63. Ehrmann S, "Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure : a randomised, controlled, multinational, open-label meta-trial", Lancet Respir Med, 9, pp.1387~1395 (2021)
  64. Papazian L, "Neuromuscular blockers in early acute respiratory distress syndrome", N Engl J Med, 363, pp.1107~1116 (2010)
  65. Moss M, "Early neuromuscular blockade in the acute respiratory distress syndrome", N Engl J Med, 380, pp.1997~2008 (2019)
  66. Tsolaki V, "Neuromuscular blockade in the pre-and COVID-19 ARDS patients", J Pers Med, 12, pp.1538~ (2022)
  67. Guervilly C, "Effects of neuromuscular blockers on transpulmonary pressures in moderate to severe acute respiratory distress syndrome", Intensive Care Med, 43, pp.408~418 (2017)
  68. Gainnier M, "Effect of neuromuscular blocking agents on gas exchange in patients presenting with acute respiratory distress syndrome", Crit Care Med, 32, pp.113~119 (2004)
  69. Forel JM, "Neuromuscular blocking agents decrease inflammatory response in patients presenting with acute respiratory distress syndrome", Crit Care Med, 34, pp.2749~2757 (2006)
  70. Combes A, "Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome", N Engl J Med, 378, pp.1965~1975 (2018)
  71. Peek GJ, "Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure(CESAR) : a multicentre randomised controlled trial", Lancet, 374, pp.1351~1363 (2009)
  72. McNamee JJ, "Effect of lower tidal volume ventilation facilitated by extracorporeal carbon dioxide removal vs standard care ventilation on 90-day mortality in patients with acute hypoxemic respiratory failure : the REST randomized clinical trial", JAMA, 326, pp.1013~1023 (2021)
  73. Bein T, "Lower tidal volume strategy(≈3 ml", kg)combined with extracorporeal CO2removal versus 'conventional' protective ventilation(6 ml, Intensive Care Med, pp.2013, 39[DOI]

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