The therapist is mechanically ventilating an ARDS patient who weighs 89 kg (IBW). The initial Vt was set at 530 ml. At that time, the Pplateau was 30 cm H2O. Now the Pplateau has increased to 35 cm H2O. What should the therapist do at this time?

A. Decrease the Vt to 5 ml/kg.
B. Maintain the Vt at 6 ml/kg, but decrease the respiratory rate.
C. Increase the Vt to 8 ml/kg.
D. Add 5 cm H2O PEEP.

ANS: A
A. Correct response: Based on the data derived from the ARDSnet study, further reduction of the Vt is necessary if the Pplateau is greater than 30 cm H2O, and increase the Vt up to 8 ml/kg if severe respiratory acidosis is present, or if severe patient-ventilator dyssynchrony is present provided that the Pplateau remains below 30 cm H2O.
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A