This paper justifies utilizing a higher tidal volume strategy for our patients without primary ARDS/pulmonary disease. This can be very useful. Patient comfort and patient-ventilator synchrony are extremely important. This is especially true for our current emphasis on providing ideal sedation and analgesia, obviating the need for paralysis unless absolutely necessary. With a higher tidal volume, patients can be kept on a lower respiratory rate to maintain the same minute ventilation, which is much more comfortable. It will also lessen the likelihood of breath-stacking or AutoPEEP. In addition, the minute ventilation can be more easily increased to compensate for acidemia, if necessary. Although some of our ventilated patients do in fact have ARDS, it is at least as common that they are intubated for extrapulmonary causes. For instance: trauma, intracranial bleeding with altered mental status, angioedema, upper GI bleeding, sepsis, etc. Even many of our patients with respiratory issues are recently intubated, and so may not have developed criteria for true ARDS at the time of transfer.

Read More