《ESICM急性呼吸窘迫综合征指南：定义、分型和呼吸支持策略》解读

中华f危重病急救医学2023年9月第35卷第9期Chin Crit Care Med,September2023,Vl.35,No.9919·标准与指南·《ESICM急性呼吸窘迫综合征指南：定义、分型和呼吸支持策略》解读急性呼吸窘迫综合征的新理念与新方法李泽蒙蒙延海李露露张燕搏中国医学科学院北京协和医学院国家心血管病中心阜外医院成人外科术后恢复中心，北京100037通信作者：张燕搏，Email:yanbozhang(@126.com【摘要】目前急性呼吸窘迫综合征(ARDS)仍然是威胁重症监护病房(ICU)患者生命健康的重要疾病之一。2023年《欧洲危重病医学会ARDS指南：定义、分型和呼吸支持策略》（以下简称“2023指南）对2017年《美国胸科学会/欧洲危重病医学会/危重病医学会临床实践指南：成人ARDS患者的机械通气》（以下简称“2017指南”)进行了更新，包括定义、分型、呼吸支持策略3个主题的7个方面内容〔即经鼻高流量氧疗(HFNO)、无创通气(NTV)、神经肌肉阻滞剂(NMBA)、体外生命支持(ECLS)、呼气末正压(PEEP)与肺复张(RM)、潮气量(VT)、俯卧位)。2023指南回顾和总结了2017指南发表以来的各类文献，涵盖了ARDS和急性低氧血症性呼吸衰竭，也包括了由新型冠状病毒感染引起的ARDS。基于最新的循证医学证据，2023指南为临床医生提供了对于成人ARDS非药物呼吸支持策略的新理念与新方法。本文对于2023指南中ARDS的新理念和新方法以及新的推荐分级和新的证据等级进行了解读。【关键词】急性呼吸窘迫综合征；急性低氧血症性呼吸衰竭；新型冠状病毒感染；指南解读D0I:10.3760/cmaj.cn121430-20230804-00579Interpretation of new concepts and approaches in the ESICM guidelines on acute respiratory distress syndrome:definition,phenotyping and respiratory support strategiesLi Zemeng,Meng Yanhai,Li Lulu,Zhang YanboDivision of Surgical Intensive Care Unit,Cardiac Surgery Department,Fuwai Hospital,National Center for CardiorascularDiseases,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,ChinaCorresponding author:Zhang Yanbo,Email:yanbochang@126.com[Abstract]Acute respiratory distress syndrome (ARDS)continues to be one of the most life-threateningconditions for patients in the intensive care unit (ICU).The 2023 European Society of Intensire Care Medicine guidelineson ARDS:definition,phenotyping and respiratory support strategies(2023 Guideline)update the 2017 An Official AmericanThoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline:mechanical ventilation in adult patients with ARDS (2017 Guideline),including 7 aspects of 3 topics of definitions,phenotyping,and respiratory support strategies [including high-flow nasal cannula oxygen (HFNO),non-invasiveventilation (NIV),neuromuscular blocking agents (NMBA),extracorporeal life support (ECLS),positive end-expiratorypressure (PEEP)with recruitment maneuvers (RM),tidal volume (VT),and prone positioningl.2023 Guideline review andsummarize the literature since the publication of the 2017 Guideline,covering ARDS and acute hypoxemic respiratoryfailure,as well as ARDS caused by novel coronavirus infection.Based on the most recent medical evidence,the2023 Guideline provide clinicians with new ideas and approaches for nonpharmacologic respiratory support strategies foradults with ARDS.This article provides interpretation of the new concepts,the new approaches,the new recommendedgrading and new levels of evidence for ARDS in the 2023 Guideline.[Key words]Acute respiratory distress syndrome;Acute hypoxemic respiratory failure;Novel coronavirusinfection;Guideline interpretationD0:10.3760Wcma.j.cm121430-20230804-00579急性呼吸窘迫综合征(acute respiratory distress2023年6月发布了《欧洲危重病医学会ARDS指南：syndrome,ARDS)患者占重症监护病房(intensive定义、分型和呼吸支持策略》[2（以下简称“2023指care unit,.ICU)患者的10.4%，占机械通气患者的南”)。2023指南对2017年的《美国胸科学会/欧