ISSN (print) 1726-9806     ISSN (online) 1818-474X
No. 4 (2025), CLINICAL GUIDELINES
No. 4 (2025)
CLINICAL GUIDELINES

Acute respiratory distress syndrome (adult patients). Clinical guidelines (2025 revision)

Published 31.10.2025
Andrey I. Yaroshetskiy
Сеченовский университет
https://orcid.org/0000-0002-1484-092X
A.I. Gritsan
Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
https://orcid.org/0000-0002-0500-2887
S.N. Avdeev
Sechenov First Moscow State Medical University, Moscow, Russia; Pulmonology Scientific Research Institute under Federal Biomedical Agency Russia, Moscow, Russia
https://orcid.org/0000-0002-5999-2150
A.V. Vlasenko
Russian Medical Academy of Continuing Professional Education, Moscow, Russia
https://orcid.org/0000-0003-3116-318X
A.A. Eremenko
Petrovsky National Research Centre of Surgery, Moscow, Russia
https://orcid.org/0000-0001-5809-8563
M.Yu. Kirov
Northern State Medical University, Arkhangelsk, Russia; City Clinical Hospital No 1 named E.E. Volosevich, Arkhangelsk, Russia
https://orcid.org/0000-0002-4375-3374
K.M. Lebedinskii
North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia; Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
https://orcid.org/0000-0002-5752-4812
I.N. Leiderman
Almazov National Medical Research Centre, St. Petersburg, Russia
https://orcid.org/0000-0001-8519-7145
V.A. Mazurok
Almazov National Medical Research Centre, St. Petersburg, Russia
https://orcid.org/0000-0003-3917-0771
А.А. Солодов
ФГБОУ ВО «Российский университет медицины» Минздрава России, Москва, Россия
https://orcid.org/0000-0002-8263-1433
D.N. Protsenko
Moscow Multidisciplinary Clinical Center “Kommunarka”, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
https://orcid.org/0000-0002-5166-3280
I.B. Zabolotskikh
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia; Kuban State Medical University, Krasnodar, Russia; Regional Clinical Hospital No 2, Krasnodar, Russia
https://orcid.org/0000-0002-3623-2546
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HTML_2025-4-7-68_S (Russian)

Keywords

guidelines
mechanical ventilation
non-invasive ventilation
high flow oxygen therapy
acute respiratory failure
ARDS
ECMO

How to Cite

Yaroshetskiy A.I., Gritsan A.I., Avdeev S.N., Vlasenko A.V., Eremenko A.A., Kirov M.Y., Lebedinskii K.M., Leiderman I.N., Mazurok V.A., Солодов А.А., Protsenko D.N., Zabolotskikh I.B. Acute respiratory distress syndrome (adult patients). Clinical guidelines (2025 revision). Annals of Critical Care. 2025;(4):7–68. doi:10.21320/1818-474X-2025-4-7-68.
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Abstract

Acute respiratory distress syndrome (ARDS) is one of the most common causes of acute respiratory failure. The updated clinical guidelines are devoted to the state-of-the-art diagnostic approach and treatment of acute respiratory distress syndrome. In the updated version of the clinical guidelines, ARDS diagnostics could be performed not only in intubated but also in non-intubated patients. The approach to the choice of diagnostic methods, intensive care and respiratory support is based on pathophysiology, data from observational and randomized studies on the problem of ARDS. Particular emphasis in the updated version of the clinical guidelines is placed on new data on the features of the clinical course, diagnosis and intensive care for various pathophysiological and clinical phenotypes of ARDS. Data on the use of non-invasive ventilation and high-flow oxygen therapy through nasal cannula in patients with ARDS have been significantly expanded. The recommendations were prepared using studies whose design corresponded to the thesis of the clinical recommendation, as well as systematic reviews and meta-analyses of randomized and non-randomized studies whose design corresponded to the thesis of the clinical recommendation. Based on the presented analysis, recommendations were given for the diagnosis and treatment of acute respiratory distress syndrome, indicating the level of evidence and class of recommendations. The updated clinical recommendations significantly expanded the section on physical activation and rehabilitation of patients with ARDS. The clinical recommendations are intended for anesthesiologists and intensivists, as well as other clinical specialties.

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