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ARDS ventilation — FRCA Final MCQ

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HardICUARDS ventilationFRCA Final

A 56-year-old man with pancreatitis develops severe hypoxaemia on ICU. Chest radiograph shows bilateral infiltrates, PaO2/FiO2 ratio is 12 kPa on PEEP 10 cmH2O, plateau pressure is 32 cmH2O and tidal volume is 8 ml/kg predicted body weight. What is the most appropriate anaesthetic technique?

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Correct answer: B — Reduce tidal volume and keep plateau pressure below 30 cmH2O

The data are consistent with ARDS, and lung-protective ventilation with lower tidal volume and plateau pressure limitation improves outcomes. Increasing tidal volume may worsen ventilator-induced lung injury. PEEP should be optimised rather than removed. Inhaled pulmonary vasodilators may transiently improve oxygenation but are not first-line mortality-improving therapy.

Reference: Faculty of Intensive Care Medicine/ICS ARDS guidance; RCoA Final FRCA Syllabus 2026