In ARDS management, which practice should be avoided to minimize lung injury?

• A. High tidal volumes
• B. Low tidal volumes
• C. Adequate PEEP
• D. Permissive hypercapnia

Answer: (A)

Avoiding overdistension of the lung is essential in ARDS care. High tidal volumes push air into already damaged and unevenly compliant lungs, leading to volutrauma and triggering more inflammation and ventilator-induced lung injury. The protective approach uses low tidal volumes (about 6 mL/kg predicted body weight) and maintains plateau pressures below about 30 cm H2O, with adequate PEEP to keep alveoli open and reduce shear injury from collapse and reopening. Permissive hypercapnia can be acceptable to achieve these lower tidal volumes, provided it’s tolerated clinically. So, the practice to avoid is using high tidal volumes, which directly increases lung injury risk.