What is the recommended tidal volume in ARDS patients on mechanical ventilation?

In the management of patients with Acute Respiratory Distress Syndrome (ARDS) on mechanical ventilation, a tidal volume of 6 ml/kg of predicted body weight is the recommended approach. This lower tidal volume strategy aims to minimize ventilator-induced lung injury and reduce the risk of over-distension of the alveoli, which can exacerbate lung injury in ARDS patients.

The rationale behind using predicted body weight instead of actual body weight is to ensure that tidal volumes are adjusted appropriately for lung mechanics, especially since ARDS often leads to a reduction in lung compliance. By calculating tidal volume based on predicted body weight, clinicians can deliver sufficient ventilation while avoiding further damage to the lungs.

This approach is supported by clinical trials, including those that established the lung protective ventilation strategy, which emphasizes low tidal volumes to improve survival rates in ARDS patients. Therefore, selecting 6 ml/kg of predicted body weight aligns with current guidelines and best practices in the management of ARDS.