ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies

Giacomo Grasselli*, Carolyn S Calfee, Luigi Camporota, Daniele Poole, Marcelo B P Amato, Massimo Antonelli, Yaseen M Arabi, Francesca Baroncelli, Jeremy R Beitler, Giacomo Bellani, Geoff Bellingan, Bronagh Blackwood, Lieuwe D J Bos, Laurent Brochard, Daniel Brodie, Karen E A Burns, Alain Combes, Sonia D'Arrigo, Daniel De Backer, Alexandre DemouleSharon Einav, Eddy Fan, Niall D Ferguson, Jean-Pierre Frat, Luciano Gattinoni, Claude Guérin, Margaret S Herridge, Carol Hodgson, Catherine L Hough, Samir Jaber, Nicole P Juffermans, Christian Karagiannidis, Jozef Kesecioglu, Arthur Kwizera, John G Laffey, Jordi Mancebo, Michael A Matthay, Daniel F McAuley, Alain Mercat, Nuala J Meyer, Marc Moss, Laveena Munshi, Sheila N Myatra, Michelle Ng Gong, Laurent Papazian, Bhakti K Patel, Mariangela Pellegrini, Anders Perner, Antonio Pesenti, Lise Piquilloud, European Society of Intensive Care Medicine Taskforce on ARDS

*Corresponding author for this work
129 Citations (Scopus)


The aim of these guidelines is to update the 2017 clinical practice guideline (CPG) of the European Society of Intensive Care Medicine (ESICM). The scope of this CPG is limited to adult patients and to non-pharmacological respiratory support strategies across different aspects of acute respiratory distress syndrome (ARDS), including ARDS due to coronavirus disease 2019 (COVID-19). These guidelines were formulated by an international panel of clinical experts, one methodologist and patients' representatives on behalf of the ESICM. The review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations and the quality of reporting of each study based on the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) network guidelines. The CPG addressed 21 questions and formulates 21 recommendations on the following domains: (1) definition; (2) phenotyping, and respiratory support strategies including (3) high-flow nasal cannula oxygen (HFNO); (4) non-invasive ventilation (NIV); (5) tidal volume setting; (6) positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM); (7) prone positioning; (8) neuromuscular blockade, and (9) extracorporeal life support (ECLS). In addition, the CPG includes expert opinion on clinical practice and identifies the areas of future research.

Original languageEnglish
JournalIntensive Care Medicine
Issue number7
Pages (from-to)727-759
Number of pages33
Publication statusPublished - Jul 2023


  • Adult
  • COVID-19/therapy
  • Critical Care
  • Humans
  • Positive-Pressure Respiration
  • Respiration, Artificial
  • Respiratory Distress Syndrome/therapy
  • Acute respiratory distress syndrome
  • Extracorporeal membrane oxygenation
  • Prognosis
  • Prone position
  • Acute hypoxemic respiratory failure
  • Non-invasive ventilation
  • Practice guidelines
  • Mechanical ventilation


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