Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome (ARMA / ARDSNet)

Prior to this trial, tidal volumes of 10–15 ml/kg were standard practice for mechanically ventilated patients with ARDS. Animal studies suggested that high tidal volumes caused ventilator-induced lung injury (VILI), but no large RCT had confirmed this in humans.

Multicenter RCT (10 centers, n=861) comparing low tidal volume ventilation (6 ml/kg predicted body weight, plateau pressure ≤30 cmH₂O) vs. traditional tidal volume (12 ml/kg PBW) in patients with ALI/ARDS.

The low tidal volume group had significantly lower 28-day mortality (31.0% vs 39.8%, p=0.007) and more ventilator-free days (12 vs 10 days, p=0.007). The trial was stopped early due to benefit.

Use 6 ml/kg predicted body weight tidal volumes in all patients with ARDS. This is the single most important intervention in ARDS management and is standard of care worldwide. Plateau pressure should be kept ≤30 cmH₂O.

The control group used unusually high tidal volumes (12 ml/kg) by modern standards. The benefit may be partly from harm reduction in the control arm. Patients with very severe ARDS may need further individualization.