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Guideline title ESICM Guidelines on Acute Respiratory Distress Syndrome: Definition, Phenotyping and Respiratory Support Strategies
Release date June 16, 2023
Developer European Society of Intensive Care Medicine (ESICM) 
Target population Adult patients with or at risk for acute respiratory distress syndrome (ARDS)
Major recommendations
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For nonintubated patients with acute hypoxemic respiratory failure not due to cardiogenic pulmonary edema or chronic lung disease
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Use high-flow nasal oxygen (HFNO) vs conventional oxygen therapy to reduce risk of intubation (strong recommendation; moderate level of evidence)
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For intubated patients with ARDS
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Use low tidal volume ventilation (ie, 4-8 mL/kg predicted body weight) vs larger tidal volumes to reduce mortality (strong recommendation; high level of evidence)
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Do not use prolonged high-pressure recruitment maneuvers (strong recommendation; moderate level of evidence) or brief high-pressure recruitment maneuvers (weak recommendation; high level of evidence)
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For intubated patients with moderate to severe ARDS
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Use prone position to reduce mortality (strong recommendation; high level of evidence)
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Do not routinely use continuous infusions of neuromuscular blockade to reduce mortality (strong recommendation; moderate level of evidence)
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Refer patients who meet criteria for ECMO (extracorporeal membrane oxygenation) to ECMO centers (strong recommendation; moderate evidence)
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