Management of ARDS - What Works and What Does Not

Am J Med Sci. 2021 Jul;362(1):13-23. doi: 10.1016/j.amjms.2020.12.019. Epub 2020 Dec 26.


Acute respiratory distress syndrome (ARDS) is a clinically and biologically heterogeneous disorder associated with a variety of disease processes that lead to acute lung injury with increased non-hydrostatic extravascular lung water, reduced compliance, and severe hypoxemia. Despite significant advances, mortality associated with this syndrome remains high. Mechanical ventilation remains the most important aspect of managing patients with ARDS. An in-depth knowledge of lung protective ventilation, optimal PEEP strategies, modes of ventilation and recruitment maneuvers are essential for ventilatory management of ARDS. Although, the management of ARDS is constantly evolving as new studies are published and guidelines being updated; we present a detailed review of the literature including the most up-to-date studies and guidelines in the management of ARDS. We believe this review is particularly helpful in the current times where more than half of the acute care hospitals lack in-house intensivists and the burden of ARDS is at large.

Keywords: Acute Respiratory Distress Syndrome (ARDS); Extracorporeal membrane oxygenation (ECMO); Lung protective strategies; Positive End Expiratory Pressure (PEEP); Prone positioning; Recruitment maneuvers.

Publication types

  • Review

MeSH terms

  • Disease Management*
  • Extracorporeal Membrane Oxygenation / methods
  • Extracorporeal Membrane Oxygenation / standards*
  • Humans
  • Positive-Pressure Respiration / methods
  • Positive-Pressure Respiration / standards
  • Practice Guidelines as Topic / standards*
  • Respiration, Artificial / methods
  • Respiration, Artificial / standards*
  • Respiratory Distress Syndrome / diagnosis
  • Respiratory Distress Syndrome / physiopathology
  • Respiratory Distress Syndrome / therapy*