Fifty years of research in ARDS VT selection in acute respiratory distress syndrome

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25 Scopus citations


Mechanical ventilation (MV) is critical in the management of many patients with acute respiratory distress syndrome (ARDS). However, MV can also cause ventilator-induced lung injury (VILI). The selection of an appropriate VT is an essential part of a lung-protective MV strategy. Since the publication of a large randomized clinical trial demonstrating the benefit of lower VTs, the use of VTs of 6 ml/kg predicted body weight (based on sex and height) has been recommended in clinical practice guidelines. However, the predicted body weight approach is imperfect in patients with ARDS because the amount of aerated lung varies considerably due to differences in inflammation, consolidation, flooding, and atelectasis. Better approaches to setting VT may include limits on end-inspiratory transpulmonary pressure, lung strain, and driving pressure. The limits of lowering VT have not yet been established, and some patients may benefit from VTs that are lower than those in current use. However, lowering VTs may result in respiratory acidosis. Tactics to reduce respiratory acidosis include reductions in ventilation circuit dead space, increases in respiratory rate, higher positive end-expiratory pressures in patients who recruit lung in response to positive end-expiratory pressure, recruitment maneuvers, and prone positioning. Mechanical adjuncts such as extracorporeal carbon dioxide removal may be useful to normalize pH and carbon dioxide levels, but further studies will be necessary to demonstrate benefit with this technology.

Original languageEnglish (US)
Pages (from-to)1519-1525
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Issue number12
StatePublished - Dec 15 2017


  • Acute respiratory distress syndrome
  • Mechanical ventilation
  • Tidal volume

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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