Patient handout

Acute Respiratory Distress Syndrome

PRODUCTION

1. Your condition

This handout is for acute respiratory distress syndrome. Your care team identified this based on: acute progressive dyspnea / hypoxemic respiratory failure (2024 global definition, matthay ajrccm 2024 pmid 37487152).

Other reasons your team may use this plan: bilateral pulmonary opacities on cxr/ct/lung-us not fully explained by cardiac failure or fluid overload (2024 global definition pmid 37487152); pao2/fio2 ≤300 on peep/cpap ≥5 or hfno ≥30 l/min fio2 ≥0.4 (2024 global definition pmid 37487152); spo2/fio2 ≤315 with spo2 ≤97% on respiratory support — resource-variable criterion (2024 global definition pmid 37487152).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
oxygen_HFNO	HFNC 30–60 L/min, FiO2 titrate to SpO2 92–96%	inhaled	continuous	FLORALI (Frat NEJM 2015 PMID 25981908) — HFNO reduced 90-d mortality vs standard O2 (HR 2.01, 95% CI 1.01–3.99 favouring HFNO) and intubation in P/F ≤200 subgroup
NIV_helmet_preferred	Helmet PEEP 8–10, PS 8–14, FiO2 titrated	NIV	continuous, ROX index q1h	Patel (JAMA 2016 PMID 27179847) — helmet NIV vs face-mask reduced intubation 18.2% vs 61.5% and 90-d mortality 34.1% vs 56.4% (single-centre, stopped early)

Plan: ARDS lung-protective ventilation + adjunct ladder (mild → severe → refractory)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

PaO2/FiO2 <150 sustained ≥12 h despite optimised lung-protective settings (PROSEVA enrolment threshold)
P/F <100 OR EOLIA refractory cut-points (P/F <50 ×3 h, <80 ×6 h, or pH <7.25 + PaCO2 ≥60 ×6 h with Pplat ≤32) despite prone + NMB(life-threatening)
Plateau pressure >30 cmH2O despite Vt 6 mL/kg PBW
Driving pressure (Pplat − PEEP) >15 cmH2O on lung-protective settings
Sudden hypoxia, hypotension, raised airway pressures in ventilated ARDS patient(life-threatening)
Echo: severe RV dilation with septal flattening, TAPSE <14 mm, persistent hypotension on vasopressor
Moderate-severe non-COVID ARDS within first 72 h OR COVID-ARDS on O2/IMV

5. Follow-up

ICU follow-up clinic, post-ICU syndrome screen (cognitive/mood/physical), pulmonary rehab, lung-function recovery 6MWT + DLCO at 3 + 6 mo (ATS 2024 PMID 38032683)

6. Sources

Guideline: 2024 Global Definition of ARDS (Matthay et al, Am J Respir Crit Care Med 2024;209:37-47) + 2024 ATS Update on Management of Adult ARDS (Qadir et al, AJRCCM 2024;209:24-36) + 2023 ESICM ARDS CPG (Grasselli)