Background: This document updates previously published Clinical Practice Guidelines for the management of patients with acute respiratory distress syndrome (ARDS), incorporating new evidence addressing the use of corticosteroids, venovenous extracorporeal membrane oxygenation, neuromuscular blocking agents, and positive end-expiratory pressure (PEEP).

Methods: We summarized evidence addressing four “PICO questions” (patient, intervention, comparison, and outcome). A multidisciplinary panel with expertise in ARDS used the Grading of Recommendations, Assessment, Development, and Evaluation framework to develop clinical recommendations.

Results: We suggest the use of: 1) corticosteroids for patients with ARDS (conditional recommendation, moderate certainty of evidence), 2) venovenous extracorporeal membrane oxygenation in selected patients with severe ARDS (conditional recommendation, low certainty of evidence), 3) neuromuscular blockers in patients with early severe ARDS (conditional recommendation, low certainty of evidence), and 4) higher PEEP without lung recruitment maneuvers as opposed to lower PEEP in patients with moderate to severe ARDS (conditional recommendation, low to moderate certainty), and 5) we recommend against using prolonged lung recruitment maneuvers in patients with moderate to severe ARDS (strong recommendation, moderate certainty).

Conclusions: We provide updated evidence-based recommendations for the management of ARDS. Individual patient and illness characteristics should be factored into clinical decision making and implementation of these recommendations while additional evidence is generated from much-needed clinical trials.

背景：本文件更新了之前发布的急性呼吸窘迫综合征(ARDS)患者管理临床实践指南，纳入了阐述使用皮质类固醇、静脉-静脉体外膜肺氧合、神经肌肉阻滞剂和呼气末正压通气 (PEEP) 的新证据。

方法：我们总结了解决4个“PICO问题”（患者、干预、比较和结局）的证据，具有ARDS专业知识的多学科专家小组使用推荐、评估、开发和评价分级框架制定临床建议。

结果：我们建议使用：1）ARDS患者使用皮质类固醇（条件性推荐，中等确定性证据），2）选定的重度ARDS患者使用静脉-静脉体外膜肺氧合（条件性推荐，低确定性证据），3）神经肌肉阻滞剂在早期重度ARDS患者中（条件性推荐，证据确定性较低），和4）在中度至重度 ARDS 患者中，无肺复张操作的PEEP高于PEEP（条件性推荐，确定性较低至中度），和5）我们建议不要在中度至重度ARDS患者中使用延长肺复张操作（强推荐，确定性中等）。

结论：我们提供了更新的循证证据ARDS管理建议。在临床决策和实施这些建议时，应考虑个体患者和疾病特征，同时从急需的临床试验中获得额外证据。