If a patient with ARDS has a plateau pressure greater than 30 cm H2O, what should the next step be in the ARDS protocol?

In the management of a patient with Acute Respiratory Distress Syndrome (ARDS), monitoring ventilator settings is crucial, particularly regarding plateau pressure. A plateau pressure greater than 30 cm H2O indicates the risk of ventilator-induced lung injury due to excessive pressure in the airways. In such cases, the appropriate response is to decrease the tidal volume gradually, specifically in 1 mL/kg increments, to reduce the overall pressure delivered to the lungs.

Lowering the tidal volume helps protect the lungs from barotrauma and prevent worsening of lung injury, a key component of ARDS management. This approach aligns with lung-protective strategies that prioritize lower tidal volumes rather than increasing them, which can exacerbate the patient's condition. Reducing tidal volumes maintains adequate ventilation while minimizing the risk of trauma to already compromised lung tissue.