《ESICM急性呼吸窘迫综合征指南:定义、表型和呼吸支持策略》解读

Interpretation of the 2023 European Society of Intensive Care Medicine guidelines on acute respiratory distress syndrome

2023年6月16日,欧洲危重症医学会(the European Society of Intensive Care Medicine,ESICM)在《重症监护医学杂志(Intensive Care Medicine,ICM)》发布了《ESICM急性呼吸窘迫综合征指南:定义、表型和呼吸支持策略》(以下简称2023版指南)。与2017版指南相比,2023版指南增加了“定义”和“表型”两个领域,但只是进行了阐述,并未给出推荐意见;针对“呼吸支持策略”,2023版指南增加了“经鼻高流量氧疗(high flow nasal cannula oxygen,HFNO)”“无创通气(noninvasive ventilation,NIV)”“神经肌肉阻滞剂”和“体外二氧化碳清除(extracorporeal carbon dioxide removal,ECCO_(2)R)”四个模块,对呼吸支持策略给出了相应的推荐意见;同时还针对2019年新型冠状病毒感染(COVID-19)患者给出了额外的推荐意见。但2023版指南并未明确给出ARDS新定义,2023年7月24日《美国呼吸与危重病医学杂志(American Journal of Respiratory and Critical Care Medicine,AJRCCM)》给出了ARDS的全球新定义,填补了2023版指南的定义部分。本文结合2023版指南及ARDS全球新定义对指南进行了解读,以供重症同仁参考。

On June 16,2023,the European Society of Intensive Care Medicine(ESICM)published ESICM guidelines on acute respiratory distress syndrome(ARDS):definitions,phenotyping,and respiratory support strategies(the guidelines 2023)in Intensive Care Medicine(ICM).Compared with the 2017 clinical practice guideline,the guidelines 2023 added two topics of"definition"and"phenotyping",but only discussed and did not give recommendations.For"respiratory support strategies",the guidelines 2023 added four modules"high flow nasal cannula oxygen(HFNO)""noninvasive ventilation(NIV)""neuromuscular blocking agents"and"extracorporeal carbon dioxide removal(ECCO 2R)",and gave the recommendations on every respiratory support strategy.Additional recommendations were also mentioned for coronavirus disease 2019(COVID-19)patients.However,the guidelines 2023 did not specify a new definition of ARDS.The American Journal of Respiratory and Critical Care Medicine(AJRCCM)had given a new global definition of ARDS on July 24,2023,filling in the definition section of the guidelines 2023.This article gave some suggestion combining with the guidelines 2023 and the new definition of ARDS for physicians of critical care medicine.