Consensus statement for managing patients with ARDS in low-resource settings: a Delphi study

Despite decades of research and advances in critical care, mortality of the Acute Respiratory Distress Syndrome (ARDS) remains high, ranging from 30 to 45% in high-income countries and markedly higher in low-resource settings (LRS), where management guidelines implementation is constrained. An international consensus aimed to provide statements for ARDS management tailored to LRS.

Since management of critically ill patients is a major public health problem in LRS, the Bosnia and Herzegovina Society of Intensive Care Medicine convened an international, multidisciplinary Steering Committee with expertise in ARDS management. The committee appointed an international panel of clinicians and investigators specialized in the field of ARDS. Through an iterative Delphi process, a panel of 52 experts developed several consensus statements.

After three Delphi rounds, consensus was reached on 44 out of 56 of statements (79%). The survey covered eight domains related to ARDS management in LRS related to: critical care infrastructure, diagnostic tools, respiratory support, other supportive therapies, sedation strategies, weaning, nutrition, and management of complications. Statements were compared with recent ESICM guidelines, highlighting specific LRS considerations.

Using the Delphi method, international experts developed clinical practice statements guiding clinicians on ARDS management in LRS. These statements complemented existing guidelines by addressing areas where evidence is limited, and highlight aspects of ARDS management pertinent for LRS not covered by current international recommendations. Future studies are needed to evaluate the adherence and impact of these statements and to address remaining uncertainties.