Respiratory management of Acute Respiratory Distress Syndrome (ARDS) in the Intensive Care Unit from Early Diagnosis: Narrative Review

This study aims to determine the optimal ventilatory technique for different levels of acute respiratory distress syndrome (ARDS) severity to reduce the need for endotracheal intubation (ETI) in the ICU. Secondary objectives include identifying predictors of failure of non-invasive ventilation (NIV), assessing the role of physiotherapists in the ICU across countries, and identifying areas for further investigation. A review of articles from 2013 to 2023 involving adults with ARDS in the ICU was conducted. The PEDro scale assessed article quality, and exclusion criteria included specific aetiologies of acute respiratory failure, extreme obesity, and pregnancy, as well as case series and case study designs. Data were extracted from PUBMED, EBSCO, and ScienceDirect, and a validated questionnaire was administered to physiotherapists in Chile, Spain, and France. Eight studies (number of patients n = 883) were included, and a questionnaire was completed by 22 physiotherapists (6 from France, 6 from Spain, 10 from Chile). Findings highlighted the management of high flow nasal cannula (HFNC) and NIV in different patient populations. Helmet NIV had an 18.2% failure rate and better outcomes than facemask interface. NIV non-response correlated with increased mortality rates. Cox analysis identified predictors of NIV failure. Caution is advised in NIV use, considering predictors of failure, and HFNC may be beneficial in mild ARDS. The majority of included studies had small sample sizes, limiting generalizability. The questionnaire results were constrained by a small sample size and lack of meta-analysis.