Most patients with ARDS will require endotracheal intubation and mechanical ventilation at some point during the course of their illness and recovery. A mechanical ventilation strategy using lower tidal volumes of 6 mL/kg predicted body weight and higher levels of positive end-expiratory pressure (PEEP) has been shown to be most effective at improving oxygenation and minimizing volutrauma (injury to stiff lungs resulting from overdistention).
As an overview, a quasi-experimental, before-after trial found reduced mortality associated with the following strategy quoted from Journal Watch:
use tidal volumes <6.5 mL/kg,
use a PEEP of 5–24 cm H20 within a plateau pressure <30 cm H20,
decrease FiO2 as permitted to achieve saturation of 88%–95%,
and elevate the head of the bed. Hypercapnia with a pH >7.25 is permissible.
Use a higher flow rate (up to 100 L/min) for obstructive airway disease when necessary to achieve a satisfactory I:E ratio
Acute respiratory distress syndrome mechanical ventilation therapy
Acute respiratory distress syndrome medical therapy
Respiratory failure mechanical ventilation
Asthma emergency management
Air embolism medical therapy
Aspiration pneumonia medical therapy
Respiratory acidosis medical therapy
Hemothorax medical therapy