In the management of adult ARDS, what tidal volume is recommended per ARDSnet guidelines?

• A. 6 mL/kg predicted body weight
• B. 8 mL/kg predicted body weight
• C. 10 mL/kg predicted body weight
• D. 4 mL/kg predicted body weight

Answer: (A)

In ARDS, the main idea is to protect the lungs during mechanical ventilation by using small tidal volumes that fit the size of the patient’s lungs. The ARDSnet findings established that about 6 mL per kilogram of predicted body weight best protects the lungs while providing adequate gas exchange. This approach helps prevent overdistension (volutrauma) of already damaged lungs and is paired with aiming for a plateau pressure no greater than 30 cm H2O. Higher tidal volumes like 8 or 10 mL/kg increase the risk of lung injury, while too small volumes such as 4 mL/kg can lead to inadequate ventilation and CO2 retention. Therefore, the recommended tidal volume is 6 mL/kg predicted body weight.