How is the target tidal volume determined for patients with acute respiratory distress syndrome (ARDS)?

Updated: Apr 07, 2020
  • Author: Ata Murat Kaynar, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Patients with ARDS should be targeted to receive a tidal volume of 6 mL/kg. It is important to remember that the set tidal volume should be based on ideal rather than actual body weight. If the plateau pressure remains excessive (>30 cm water), further reductions in tidal volume may be necessary.

ARDSNet, a prospective randomized clinical trial, demonstrated a striking reduction in hospital mortality in ARDS patients who were ventilated with 6 mL/kg predicted body weight rather than with 12 mL/kg. [3] Patients who received the lower tidal volume strategy also had more ventilator-free and organ failure-free days. This strategy may lead to respiratory acidosis, which requires either high respiratory rates and or sodium bicarbonate infusion.


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