🫁 ARDS Lung-Protective Ventilation (ARDSnet)
Lung-protective ventilation settings for ARDS, centered on low tidal volume and plateau-pressure/driving-pressure limits.
ARDS Lung-Protective Ventilation (ARDSnet)
Sex
Height (cm)
When to use
Use in mechanically ventilated ARDS patients to set tidal volume by predicted body weight and to check whether plateau pressure, driving pressure, and oxygenation targets are met.
How it works
Low tidal volume 4–8 mL/kg predicted body weight (start ~6); plateau pressure ≤ 30 cmH₂O; driving pressure (Pplat − PEEP) ideally < 15 cmH₂O; permissive hypercapnia tolerated; titrate PEEP/FiO₂ to oxygenation; prone positioning for severe ARDS (P/F < 150).
Key points
- Tidal volume is set by predicted (not actual) body weight — the lung size tracks height and sex, not weight (original synthesis · not guideline verbatim).
- Driving pressure has emerged as a strong mortality-associated variable; keeping it low can matter even when tidal volume is already limited.
- Severe ARDS benefits from prone positioning ≥ 16 h/day and consideration of neuromuscular blockade and ECMO referral.
References
- ARDSNet (ARMA) low tidal volume trial. N Engl J Med 2000.
- Amato MBP, et al. Driving pressure and survival in ARDS. N Engl J Med 2015.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.