In a patient with ARDS being ventilated with lung-protective strategy, which combination best reflects ARDSnet ventilation targets?
- A Tidal volume 10 mL/kg IBW, PEEP 5 cmH2O, plateau pressure <45 cmH2O
- B Tidal volume 8 mL/kg IBW, PEEP 10 cmH2O, maintain PaCO2 35–45 mmHg strictly
- C Tidal volume 6 mL/kg IBW, plateau pressure <30 cmH2O, driving pressure <15 cmH2O, permissive hypercapnia acceptable ✓
- D Pressure-controlled ventilation with inspiratory pressure 30 cmH2O and I:E ratio 2:1
Correct answer: C. Tidal volume 6 mL/kg IBW, plateau pressure <30 cmH2O, driving pressure <15 cmH2O, permissive hypercapnia acceptable
Explanation
ARDSnet lung-protective ventilation uses tidal volumes of 6 mL/kg ideal body weight (IBW), targets plateau airway pressure <30 cmH2O, and applies driving pressure (plateau minus PEEP) <15 cmH2O to minimise cyclic stretch injury (volutrauma/atelectrauma). Permissive hypercapnia (accepting PaCO2 up to 60–80 mmHg) is tolerated to avoid high tidal volumes. PEEP is set via FiO2-PEEP tables to maintain adequate oxygenation (SpO2 88–95%). This strategy, proven in the original ARDSnet trial (2000), reduced mortality from 40% to 31%.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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