Saudi Guideline for Mechanical Ventilation in Adults – Executive Summary

The Saudi Guideline for Mechanical Ventilation in Adults presents evidence-based recommendations for the care of adults requiring invasive mechanical ventilation. Fourteen priority clinical questions address ventilatory strategies for acute respiratory distress syndrome (ARDS), adjunctive and rescue therapies, sedation and weaning practices, airway management, and supportive ICU care. Strong recommendations support low-tidal-volume ventilation and higher positive end-expiratory pressure in ARDS, as well as head-of-bed elevation to prevent ventilator-associated pneumonia. Conditional recommendations include prone positioning, venovenous extracorporeal membrane oxygenation in selected severe ARDS patients, daily sedation interruption, protocolized spontaneous breathing trials, and early tracheostomy. For several interventions, evidence remains insufficient to support definitive recommendations. This guideline aims to standardize practice and improve outcomes across Saudi intensive care units.