In ARDS, which ventilator strategy improves mortality?

• A. High tidal volume ventilation
• B. APRV
• C. High-frequency oscillatory ventilation
• D. Low tidal volume ventilation with adequate PEEP

Answer: (D)

In ARDS, the goal is to minimize ventilator-induced lung injury while maintaining oxygenation. Using low tidal volumes (about 6 ml/kg predicted body weight) reduces volutrauma and biotrauma by preventing overdistension of injured and healthy lung tissue. Keeping plateau pressures under roughly 30 cm H2O helps avoid barotrauma. Adding adequate PEEP keeps alveoli open, improving oxygenation and reducing repetitive opening and closing that drives further injury. Large trials show that this lung-protective strategy lowers mortality compared with high tidal volumes. Other approaches like higher volumes or certain alternative modes have not demonstrated a survival benefit and can be harmful. So, low tidal volume ventilation with adequate PEEP is the strategy most consistently associated with improved outcomes in ARDS.