In ARDS, the recommended tidal volume is approximately:

• A. 4
• B. 8
• C. 12
• D. 6

Answer: (D)

In ARDS, the goal is to protect the lungs from further injury while providing adequate ventilation, so tidal volumes are kept low to avoid overdistending the damaged alveoli. The recommended target is about 6 mL per kilogram of predicted body weight, not actual body weight, because it balances enough ventilation with minimizing volutrauma. This approach, supported by major trials, also pairs with monitoring to keep plateau pressures around or below 30 cm H2O to limit pressure-related injury. A tidal volume around 8 mL/kg is generally higher than what the ARDS population should receive, increasing the risk of lung injury, while 12 mL/kg would overinflate the lungs. Tidal volumes as low as 4 mL/kg can lead to problematic CO2 retention without proven additional benefit in most cases. So, roughly 6 mL/kg PBW is the best balance for protecting the injured lung.