What is the first intervention for a patient with ARDS and diminished breath sounds?

• A. Administer diuretics
• B. Elevate HOB
• C. Administer bronchodilator
• D. Increase PEEP

Answer: (B)

When breath sounds are diminished in a patient with ARDS, the first move is to optimize airway mechanics and oxygenation with a simple, noninvasive intervention. Elevating the head of the bed helps the lungs expand more effectively by allowing better diaphragmatic movement and increased lung volumes, especially in the dependent regions. This position also reduces the risk of aspiration and can improve overall oxygenation quickly while you assess for secretions, airway patency, or the need for further ventilator adjustments.

Bronchodilators would be more appropriate if there’s a concurrent bronchospasm or reactive airway component, but they don’t address the immediate issue of poor air entry seen with ARDS. Diuretics target fluid overload and are not the first choice in noncardiogenic edema. Increasing PEEP is a key ventilator strategy for alveolar recruitment in ARDS, but the initial step at the bedside, before adjusting ventilator settings, is to optimize positioning to improve ventilation.