In ARDS management, which ventilation approach is associated with reduced ventilator-induced lung injury?

• A. Low tidal volume ventilation
• B. High tidal volume ventilation
• C. No PEEP
• D. Spontaneous breathing trials only

Answer: (A)

Small, careful breaths protect the injured lungs. In ARDS the lungs are stiff and uneven, so delivering large tidal volumes tends to overdistend the healthier areas and trap pressure in the opened and damaged regions. This volutrauma and the associated high plateau pressures drive ventilator-induced lung injury. Using low tidal volumes (around 6 mL/kg of predicted body weight) with careful monitoring to keep plateau pressures below about 30 cm H2O minimizes stretch and pressure on the lung tissue, thereby reducing injurious forces from ventilation. This approach has been shown to improve outcomes in ARDS by limiting ventilator-induced injury. While PEEP helps prevent repeated opening and closing of alveoli, and spontaneous breathing trials aid weaning, the key factor specifically associated with reducing lung injury from ventilation is keeping tidal volumes low to prevent overdistension. High tidal volumes increase injury, no PEEP can worsen atelectrauma, and relying only on spontaneous trials doesn’t directly address the injury caused by overdistension.