lung-protective ventilation
A ventilator can keep someone alive, but the very breaths it delivers can, paradoxically, harm the lungs — overstretching tissue, repeatedly snapping air sacs open and shut, and feeding inflammation. Lung-protective ventilation is the strategy built to avoid that self-inflicted damage: ventilate gently, with the smallest pressures and volumes that still do the job, so the machine supports the lungs without injuring them.
The strategy bundles several measures that work together. It uses low tidal volumes (around six millilitres per kilogram of predicted body weight) so breaths do not overstretch tissue; it keeps the plateau and driving pressures within safe limits; and it applies enough positive end-expiratory pressure to stop air sacs from collapsing and reopening with each breath. The price of small breaths — a tendency for carbon dioxide to climb — is usually tolerated rather than corrected aggressively.
This approach grew out of landmark ARDS trials that found lower tidal volumes saved lives, and its principles now guide ventilation broadly, including for patients with healthy lungs. An honest caveat: protective settings can feel uncomfortable and may require deeper sedation, and they are a framework rather than a one-size-fits-all recipe — pressures and volumes are still individualised and adjusted to each patient's lungs and response.
Managing a patient with ARDS, the team caps the tidal volume at six millilitres per kilogram, keeps the plateau pressure under thirty, and sets adequate PEEP — a lung-protective bundle that limits further injury.
Small breaths, capped pressures, and adequate PEEP together protect the lungs.
Limiting the driving pressure — the difference between the plateau pressure and PEEP — has emerged as one of the strongest single predictors of survival in ventilated ARDS.