New international guidelines on the management of respiratory diseases in intensive care. The Italian Giacomo Grasselli, director of the Anesthesia and Intensive Care Unit for adults at the Milan Polyclinic, is the first signatory to the work published in ‘Intensive Care Medicine’, which capitalized on the experience of the Covid-19 pandemic. Grasselli led a group of experts from the European Society for Intensive Care (Esicm), whose indications concern in particular the so-called acute respiratory distress syndrome (ARDS). In the intensive care units – they explain from the Milanese Irccs – about one in 10 patients has Ards, a pathology greatly increased due to Sars-CoV-2, but which can also have other origins. Ards in more than one in 4 cases (23%) require the application of mechanical ventilation, and kill almost one in 2 people (45%) among the most seriously ill patients.
Acute respiratory distress syndrome – details a note – consists of widespread damage to the alveoli, the structures that allow the lungs to let us breathe. The damage is mainly localized at the level of the capillaries surrounding the alveoli: if they cannot function properly, they cannot introduce oxygen into the body or eliminate carbon dioxide, causing severe respiratory failure. For these reasons, it is not enough to give the patient more oxygen (the damage to the alveoli would not allow it to be used correctly), but mechanical ventilation must often be used. However, forcibly ventilating the lungs can damage them if things are not done extremely precisely and considering all clinical aspects of the patient. This is where the guidelines come into play, a fundamental tool for specialists because they summarize all the scientific discoveries on the subject accumulated over the years and structure them clearly, codifying specific paths on patient management, homogeneous at European level. The newly published guidelines update and replace those of 2017, and concern adult patients.
“I am very satisfied with the publication of these guidelines – comments Grasselli – They are the result of 2 years of work involving all the major international experts, as well as methodologists and patient representatives. I am particularly proud of the fact that even the prestigious journal ‘ Journal of the American Medical Association’ dedicated an article to the new ESICM guidelines, recognizing that they represent an important tool to improve the care of patients with ARDs and to guide future research on this pathology”.