Which ventilation strategy reduces driving pressures in ARDS?

The strategy of using lower tidal volumes with adequate PEEP is effective in reducing driving pressures in patients with ARDS due to its ability to minimize lung stress while maintaining adequate oxygenation. ARDS is characterized by reduced lung compliance and increased airway resistance, leading to higher pressures required to deliver mechanical ventilation.

By employing a lower tidal volume strategy, typically 6 ml/kg of predicted body weight, it reduces the volume of air delivered with each breath, thereby decreasing the peak inspiratory pressure needed to achieve adequate ventilation. Additionally, incorporating adequate levels of PEEP helps recruit collapsed alveoli, more evenly distributing ventilation throughout the lung and improving gas exchange. This balance aids in preventing further lung injury by decreasing the risk of volutrauma and barotrauma associated with higher tidal volumes.

The other strategies mentioned may lead to higher driving pressures or not effectively address the complications associated with ARDS. Higher tidal volumes with low PEEP may result in increased plateau pressures, which can exacerbate lung injury. Assist-control mode may also lead to higher tidal volumes, depending on patient effort, and does not specifically target the reduction of driving pressures. High-frequency oscillatory ventilation may be an alternative approach but is less commonly used and may not consistently reduce driving pressures in the same manner as