Treatment of ARDS is primarily supportive. Currently, mechanical ventilation is the mainstay of therapy for ARDS. The principal goal of mechanical ventilation is to allow time for the lungs to heal. Unfortunately, mechanical ventilation can cause further lung injury, known as ventilator-induced lung injury (VILI). Excessive alveolar volumes (volutrauma), high mean and peak airway pressures (barotrauma), and shear forces caused by frequent collapse and opening of alveolar units contribute to VILI.

Investigators have looked at protective ventilator strategies in patients with ARDS. Amato et al used a strategy to limit peak inspiratory pressures by using low tidal volumes (<6 mL/kg) and the institution of PEEP. Their approach was associated with lower 28-day mortality (38% vs 71%), a higher weaning rate (66% vs 29%), and a lower barotrauma rate (7% vs 42%).

The National Heart, Lung, and Blood Institute ARDS Network reported improved survival with a low tidal volume strategy (6 vs 12 mL/kg). Moreover, there was a decrease in mortality of approximately 25% in the intervention group compared with the control group.

References

• Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338:347-354.
• Brower RG, Ware LB, Berthiaume Y, et al. Treatment of ARDS. Chest. 2001;120:1347-1367.
• Faugno AJ, Epstein SK. Acute respiratory failure. In: Kellerman RD, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy. 1st ed. Elsevier; 2025:913-918.
• Thomson BT, Bernard GR. ARDS Network (NHLBI) studies: successes and challenges in ARDS clinical research. Crit Care Clin. 2011;27:459-468.