| 摘要: |
| ［摘要］ 随着科学研究和临床实践的进展，近5年急性呼吸窘迫综合征（ARDS）的诊治策略取得了长足发展。基于此，2023年欧洲重症医学学会（ESICM）和美国胸科协会（ATS）在2017年ARDS临床实践指南（CPG）的基础上，分别对ARDS治疗策略进行了更新和修订。ESICM新指南从ARDS定义、表型和呼吸支持策略3大主题的9个关键领域提出了21项推荐意见。ATS新指南则在2017 CPG的基础上，纳入了关于糖皮质激素、静脉-静脉体外膜氧合、神经肌肉阻断剂以及呼气末正压应用的新证据，并进行了条件限制性推荐。在特定临床问题的推荐意见上存在差异除外，两者总体上保持一致。该文对ESICM新指南和ATS新指南进行比较分析，以期为在临床实践中进行合理的循证决策提供可靠依据。 |
| 关键词: 急性呼吸窘迫综合征 临床实践指南 呼气末正压 神经肌肉阻断剂 静脉-静脉体外膜氧合 |
| DOI：10.3969/j.issn.1674-3806.2024.02.01 |
| 分类号:R 563.8 |
| 基金项目:国家自然科学基金专项（编号：82341032）；国家自然科学基金重点项目（编号：81930058）；科技部国家重点研发计划项目（编号：2022YFC2504400）；江苏医学重点实验室项目（编号：ZDXYS202205） |
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| Differences and similarities between the new guidelines of ESICM and ATS in 2023 for acute respiratory distress syndrome |
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YUAN Xueyan, LIU Ling, QIU Haibo
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Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing 210009, China
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| Abstract: |
| ［Abstract］ With the development of scientific research and clinical practice, the diagnosis and treatment strategies for acute respiratory distress syndrome(ARDS) have made great progress in the past five years. Therefore, in 2023, European Society of Intensive Care Medicine(ESICM) and American Thoracic Society(ATS) updated and revised their management strategies for ARDS based on the ARDS clinical practice guideline(CPG) in 2017. The new guideline of ESICM makes 21 recommendations from nine key fields across the three themes of ARDS definition, phenotype and respiratory support strategy. Based on the CPG in 2017, the new guideline of ATS incorporates new evidence regarding the use of corticosteroids, veno-venous extracorporeal membrane oxygenation, neuromuscular blocking agents and positive end-expiratory pressure, providing conditional recommendations. Both guidelines share a considerable degree of consistency but differences in some specific clinical issues. This review compares and analyzes the new guideline of ESICM and the new guideline of ATS, in order to provide a reliable basis for rational evidence-based decision-making in clinical practice. |
| Key words: Acute respiratory distress syndrome(ARDS) Clinical practice guideline(CPG) Positive end-expiratory pressure Neuromuscular blocking agents Veno-venous extracorporeal membrane oxygenation(VV-ECMO) |
