Phase 2: Summary of Comments

Group 5: ARDS/ALI

• 
  
• Best practice recommendations
  • Recommendation 1
  • Expert Opinion
  • Recommendation 2
    

Best practice recommendations

Recommendation 1: Patients diagnosed with ARDS/ALI might be positioned in prone position as soon as possible following diagnosis to improve oxygenation for a period of at least 6 hours and a maximum of 20 hours per day

STRENGTH: The meta-analysis (Alsighir et al 2008) based on the results of 5 high quality RCT’s concluded that prone positioning significantly improves oxygenation. No effect was established on survival; time on the ventilator or incidence of ventilator associated pneumonia. Whether this improved oxygenation could affect long term outcome including quality of life is not clear, and concerns have been raised to the high burden of implementation

Quality of evidence: moderate quality evidence: A well conducted meta analyses based on five high quality RCT’s. The evidence is downgraded due to imprecision of data (wide CI)

POSTED COMMENTS:

Reformulation of recommendation

Expert Opinion

Compliance with proning procedure is expected to increase with the implementation of a procedural protocol (Ball et al 2001; Alsaghir et al 2008; Rowe 2004)

AGREEMENT:3/5
DISAGREEMENT: 1/5
NO RESPONSE: 1/5

POSTED COMMENTS:

• Not with the amount of people we prone now compared to 7 years ago

Recommendation 2:

The routine suctioning of patients diagnosed with ARDS/ALI is not recommended and patients might only be suctioned when clinically indicated. VHI (two hyperinflations using the CPAP function of the ventilator to an airway pressure of 45cmH2O for 20 s, with an interval of 1 min in between) could be included in combination with suction to improve oxygenation after endo tracheal suction procedure.

Strength: Weak recommendation: The implementation of this recommendation is not associated with extra cost or an increased burden. However potential harm is not clear

Quality of evidence: moderate quality evidence: One randomized crossover study (Dyhr et al 2003) downgraded due to imprecision of data.

POSTED COMMENTS:

• Recommendation does not specify closed suction is required.

Reformulation of recommendation