ARDS Respiratory Support Update

The 2023 European Society of Intensive Care Medicine guidelines provide a framework for managing acute respiratory distress syndrome (ARDS) and acute hypoxemic respiratory failure. Dr. Eddy Fan emphasizes that these recommendations serve as clinical guides rather than absolute rules, prioritizing lung-protective strategies. Low tidal volume ventilation remains the standard of care, while high-flow nasal oxygen effectively reduces intubation rates despite lacking a proven mortality benefit. Prone positioning, when initiated early for at least 16 hours, acts as a vital lung-protection maneuver rather than a late-stage rescue therapy. Conversely, evidence discourages prolonged high-pressure recruitment maneuvers and extracorporeal CO2 removal, which correlate with increased patient harm. ECMO remains a viable option for severe ARDS when managed in experienced centers, provided clinicians adhere to established physiological criteria and maintain a focus on maximizing attentiveness while minimizing invasiveness.