Lesson 1Lung-protective ventilation principles: low tidal volume strategy and plateau pressure limitsThis section consolidates lung‑protective ventilation principles in ARDS, emphasizing low tidal volume strategy, plateau pressure limits, appropriate PEEP, and avoidance of excessive driving pressure, with practical bedside implementation and troubleshooting tips.
Evidence for low tidal volume ventilationSetting and monitoring plateau pressure limitsRole of PEEP in lung protectionTargeting lower driving pressures in ARDSTroubleshooting when targets not achievableLesson 2Initial ventilator settings for moderate ARDS: calculating predicted body weight, tidal volume targets, RR adjustments and permissive hypercapniaThis section details initial ventilator settings for moderate ARDS, including calculating predicted body weight, setting low tidal volume targets, adjusting respiratory rate, and applying permissive hypercapnia while monitoring pH, hemodynamics, and patient comfort.
Calculating predicted body weight at bedsideSetting tidal volume 4–8 mL/kg PBWInitial respiratory rate and minute ventilationTargets and limits for permissive hypercapniaAdjusting settings for acidosis and dyssynchronyLesson 3PEEP/FiO2 titration strategies: ARDSNet low/high PEEP tables, driving pressure approach, and individualized PEEP selectionThis section reviews PEEP/FiO2 titration strategies in ARDS, including ARDSNet low and high PEEP tables, driving pressure‑guided adjustment, and individualized PEEP selection using compliance, hemodynamics, and oxygenation response at the bedside.
Using ARDSNet low PEEP/FiO2 tablesUsing ARDSNet high PEEP/FiO2 tablesDriving pressure‑guided PEEP adjustmentAssessing compliance and oxygenation responseHemodynamic impact of higher PEEP levelsLesson 4Adjuncts for refractory hypoxemia: recruitment maneuvers, neuromuscular blockade indications, prone positioning criteria and protocolsThis section reviews adjunctive strategies for refractory hypoxemia in ARDS, including recruitment maneuvers, indications for neuromuscular blockade, and detailed criteria and protocols for prone positioning, with emphasis on safety, timing, and monitoring response.
Indications and contraindications for recruitmentRecruitment maneuver techniques and safetyNeuromuscular blockade indications and dosingProne positioning selection criteriaProne positioning procedure and monitoringLesson 5Pathophysiology of ARDS and implications for mechanical ventilationThis section explains ARDS pathophysiology, including diffuse alveolar damage, heterogeneity of lung units, and altered compliance, and links these mechanisms to ventilator strategies that limit overdistension, cyclic collapse, and oxygen toxicity in the injured lung.
Diffuse alveolar damage and edema formationHeterogeneous lung units and baby lung conceptCompliance, elastance, and chest wall effectsImpact on gas exchange and dead spaceTranslating physiology into ventilator strategyLesson 6Monitoring and measuring plateau pressure, driving pressure, and transpulmonary pressure conceptsThis section clarifies measurement and interpretation of plateau pressure, driving pressure, and transpulmonary pressure, describing bedside techniques, normal and target ranges, and how these parameters guide lung‑protective ventilator adjustments in ARDS.
How to measure plateau pressure correctlyCalculating and targeting driving pressureConcept and estimation of transpulmonary pressureUse of esophageal manometry in ARDSUsing pressures to guide ventilator changesLesson 7Ventilator modes suitable for moderate ARDS (volume-control, pressure-control, PRVC) and mode selection rationaleThis section compares volume‑control, pressure‑control, and PRVC modes for moderate ARDS, outlining advantages, limitations, and selection rationale, including control of tidal volume, peak and plateau pressures, and patient–ventilator synchrony.
Key features of volume‑control ventilationKey features of pressure‑control ventilationPrinciples and behavior of PRVC modesChoosing a mode based on ARDS severityManaging asynchrony across different modesLesson 8Weaning readiness considerations during the first 24 hours and strategies to avoid derecruitmentThis section addresses weaning readiness during the first 24 hours of ARDS ventilation, focusing on cautious assessment of stability, strategies to avoid derecruitment during early reductions in support, and coordination with sedation and mobilization plans.
Criteria for early weaning readiness in ARDSSafe reduction of FiO2 and PEEPAvoiding derecruitment during ventilator changesSedation, comfort, and spontaneous effortCoordination with early mobilization plansLesson 9Oxygenation targets and FiO2 weaning protocols (SpO2 and PaO2 goals)This section defines safe oxygenation targets in adult ARDS, compares SpO2 and PaO2 goals, and outlines stepwise FiO2 weaning protocols that minimize oxygen toxicity while preventing hypoxemia, including bedside monitoring and escalation criteria.
Recommended SpO2 and PaO2 targets in ARDSBalancing hypoxemia risk and oxygen toxicityStepwise FiO2 weaning protocols in ICURole of ABG and oximetry in titrationAdjusting targets in shock or brain injuryLesson 10Monitoring for ventilator-induced lung injury (VILI): barotrauma, volutrauma, atelectrauma—clinical and imaging surveillanceThis section outlines recognition and monitoring of ventilator‑induced lung injury, including barotrauma, volutrauma, and atelectrauma, with emphasis on clinical signs, ventilator waveform changes, imaging surveillance, and preventive ventilator adjustments.
Mechanisms of barotrauma and clinical signsRecognizing volutrauma on ventilator dataAtelectrauma and cyclic recruitment patternsRole of chest imaging in VILI detectionPreventive ventilator adjustments for VILI
