Acute Respiratory Failure

The Acute Respiratory Failure section is led by Leo Heunks.
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RESOURCES
EDUCATION
Courses
ARF & MV learning pathway
– Level 1: Foundation Course in Acute Respiratory Failure and Mechanical Ventilation
– Level 2: Transition Course in Acute Respiratory Failure and Mechanical Ventilation
– Level 3: Advanced Course in Acute Respiratory Failure & Mechanical Ventilation
ECLS/ECMO pathway
– Level 1: Foundation Course in ECLS/ECMO
– Level 3: Advanced Course in ECLS/ECMO
– Level 3: Advanced Case-Based ECLS/ECMO Course
Webinars & Podcasts
Webinars
– Hantavirus webinar
– SSC Webinar 3: Haemodynamic and fluid management
– About permissive hypercapnia physiology and clinical recommendations
– Ventilation under pressure
– Respiratory drive and effort in daily practise
– Protective Mechanical Ventilation: How I do it in practice?
Podcasts
– Inflammatory subphenotypes in patients at risk of ARDS: evidence from the LIPS-A trial
– ARDS Phenotyping: from disease understanding to future bedside perspectives
– Esophageal pressure: use in acute hypoxemic respiratory failure
– The 2023 ESICM ARDS guidelines: paper release and webinar
– Management of ARDS – What is new?
Free webinars and podcasts are available for members & non members on LIVES-STREAM.
Use your ESICM credentials or create an account
RESEARCH
Projects
APRONET
APRONET is a ONE-day prevalence study initiated by the ESICM Acute Respiratory Failure Section (ARF), which will be repeated four times during a one year period. It is a multicentre observational prospective study with no patient follow-up. Prone position is used in almost 14% of severe ARDS patients according to the results of the LUNG-SAFE study. This rate is rather low given the results of the most recent trial that showed a beneficial effect of proning on patient outcome, a finding which is in line with previous meta-analyses. The reasons why the use of proning is still limited are unclear.
WEAN SAFE
WorldwidE AssessmeNt of Separation of pAtients From ventilatory assistancE is a multi-centre, prospective, observational, 4-week inception cohort study being carried out by the Acute Respiratory Failure section of ESICM. Weaning represents a challenge for intensivists and patients spend a considerable amount of time in being liberated from mechanical ventilation. While guidelines do exist on the classification of weaning, a recent study has shown that these may not be applicable to all patients.
SUPERNOVA
A Strategy of UltraProtective lung ventilation With Extracorporeal CO2 Removal for New-Onset moderate to seVere ARDS. It was a pilot trial; a feasibility and safety trial This study will assess changes in pH/ PaO2 /PaCO2, Respiratory Rate and device CO2 clearance in the first 24 hours of ECCO2R following VT and plateau pressure reduction in patients with moderate ARDS. Safety variables during treatment will also be analysed.
LUNG SAFE
Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE is a multicentre, prospective, observational, 4-week inception cohort study, which has been carried out by the Acute Respiratory Failure section through the ESICM Trials Group. The study aimed to prospectively assess the burden of, management and therapeutic approaches to, and outcomes from acute hypoxaemic respiratory failure requiring ventilatory support, with a specific focus on ARDS as defined by the Berlin Definition.
PROJECT GROUPS
– ECMO Project Group: Michael Quintel
To examine the indications for extracorporeal technologies [ECMO. Extracorporeal CO2 removal, etc]
– Pneumonia Project Group: Head Maria Deja
Surveys
– Evaluating Practices in REhabilitation during WEANing From Mechanical Ventilation
– Train ECMO
Publication: Martucci et al. Hemoglobin trigger and approach to red blood cell transfusions during veno-venous extracorporeal membrane oxygenation: the international TRAIN-ECMO survey
Guidelines and consensus statement
2025
Ostermann, M., Alshamsi, F., Artigas Raventos, A. et al. European Society of Intensive Care Medicine Clinical Practice Guideline on fluid therapy in adult critically ill patients: Part 3—fluid removal at de-escalation phase. Intensive Care Med (2025). https://doi.org/10.1007/s00134-025-08058-x Published online on 19 August 2025.
Mongodi, S., Cortegiani, A., Alonso-Ojembarrena, A. et al. ESICM—ESPNIC international expert consensus on quantitative lung ultrasound in intensive care. Intensive Care Med51, 1022–1049 (2025). https://doi.org/10.1007/s00134-025-07932-y . Published online on 12 May 2025.
Mekontso Dessap, A., AlShamsi, F., Belletti, A. et al. European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2—the volume of resuscitation fluids. Intensive Care Med (2025). https://doi.org/10.1007/s00134-025-07840-1. Published online on 31 March 2025
2024
Demoule, A., Decavele, M., Antonelli, M. et al. Dyspnoea in acutely ill mechanically ventilated adult patients: an ERS/ESICM statement. Intensive Care Med50, 159–180 (2024). https://doi.org/10.1007/s00134-023-07246-x. Published on 22 February 2024.
Arabi, Y.M., Belley-Cote, E., Carsetti, A. et al. European Society of Intensive Care Medicine clinical practice guideline on fluid therapy in adult critically ill patients. Part 1: the choice of resuscitation fluids. Intensive Care Med50, 813–831 (2024). https://doi.org/10.1007/s00134-024-07369-9
Relevant Literature
Greendyk et al. Gattinoni’s Legacy: Personalizing ARDS Management Through Physiology
Review work Gattinoni – 2025
Robba et al. Ventilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study.
Original – 2025
Tuinman et al. How we use ultrasound in the management of weaning from mechanical ventilation.
Review – 2025
Stadlbauer et al. Management of high-risk acute pulmonary embolism: an emulated target trial analysis.
Original – 2025
Azoulay et al. Outcomes in immunocompromised patients with acute hypoxemic respiratory failure treated by high-flow nasal oxygen.
Original – 2025
Mongodi et al. How we use critical care ultrasound in the management of ventilatory settings in ARDS patients.
Review – 2025
Duan et al. Low versus high positive end expiratory pressure in noninvasive ventilation for hypoxemic respiratory failure: a multicenter randomized controlled trial.
Original – 2025
Pettenuzzo et al. Prone positioning during veno-venous extracorporeal membrane oxygenation: a systematic review and meta-analysis.
Review – 2025
Frat et al. Noninvasive respiratory supports in ICU.
Review – 2025
Combes et al. Extracorporeal life support for adult patients with ARDS.
Review – 2025
Futier et al. Personalized driving pressure-guided positive end-expiratory pressure in patients at risk of postoperative respiratory failure (IMPROVE-2): a multicenter, pragmatic, randomized clinical trial.
Original – 2025
Thille et al. Characteristics of ventilator weaning in patients intubated for Guillain–Barré syndrome or myasthenia gravis: a nationwide multicenter study
Review – 2025