In a patient with ARDS who is receiving mechanical ventilation, what should be decreased to improve their outcome?

In patients with Acute Respiratory Distress Syndrome (ARDS), lung protective ventilation strategies are critical for improving outcomes. One of the key components of these strategies is the reduction of tidal volume (VT) to minimize ventilator-induced lung injury. The goal is to use lower tidal volumes, typically around 6 mL/kg of predicted body weight, which helps reduce the risk of over-distension of alveoli and further lung injury.

By decreasing the tidal volume to 400 mL, the ventilation strategy aligns with the lung protective approach recommended in ARDS management, helping to prevent barotrauma and volutrauma to compromised lung tissue. This adjustment can lead to improved oxygenation and reduced mechanical ventilation-associated complications.

In contrast, increasing PEEP, starting ECMO, or simply decreasing FIO2 without a careful strategy can potentially lead to further complications or inadequate oxygenation. Therefore, adjusting the tidal volume plays a significant role in stabilizing the patient's condition and can lead to better outcomes in the management of ARDS.