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ARDS: Optimal tidal volume

The Acute Respiratory Distress Syndrome Network (ARDS Net) has performed a number of well executed clinical trials designed to provide an evidence base for the care of patients with Acute Lung Injury (ALI) and ARDS. Note: ALI and ARDS exist on a continuum and may be due to a variety of etiologies (aspiration, bacterial pneumonia, viral pneumonia, trauma, transfusion related lung injury, etc.). It has been demonstrated that lung injury can occur at both low pressures (atelectrauma) and high volumes/pressures (volutrauma and barotrauma) in ALI/ARDS. ARDS Net data indicates that tidal volumes should be VOLUME LIMITED to 6 ml/kg (less than or equal to 6ml/kg) and end-inspiratory plateau-pressure limit of 30 cm H2O (NEJM, 2000).

A subsequent trial looking at high vs. low PEEP (8 vs. 13 cm H2O) showed no additional benefit to manipulation of PEEP beyond limiting Tidal Volume (Brower et al. NEJM 2004).


  1. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N. Engl. J. Med.: 2000, 342(18);1301-8 PubMed Link
  2. Roy G Brower, Paul N Lanken, Neil MacIntyre, Michael A Matthay, Alan Morris, Marek Ancukiewicz, David Schoenfeld, B Taylor Thompson, National Heart, Lung, and Blood Institute ARDS Clinical Trials Network Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N. Engl. J. Med.: 2004, 351(4);327-36 PubMed Link

Other References

  1. Acute Respiratory Distress Syndrome Link