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Acute respiratory distress syndrome — SCE Respiratory MCQ

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HardRespiratory Failure/NIVAcute respiratory distress syndromeSCE Respiratory

A 45-year-old man with severe pneumonia develops refractory hypoxaemia in ICU. Ventilator settings show tidal volume 9 mL/kg predicted body weight and plateau pressure 34 cmH2O. PaO2/FiO2 is 13 kPa with bilateral infiltrates and no cardiac failure. What is the most appropriate ventilation strategy?

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Correct answer: C — Lung-protective ventilation with lower tidal volume and plateau pressure target

ARDS should be ventilated with lung-protective low tidal volume and limitation of plateau pressure to reduce ventilator-induced lung injury. Increasing tidal volume may worsen barotrauma and mortality. PEEP and proning are considered according to severity, but extubation or removing PEEP is unsafe here.

Reference: Faculty of Intensive Care Medicine/ARDS guidance; ARDSNet evidence