77. RFJC 9 – ARDS Series – ARMA

Lung-protective ventilation, defined by tidal volumes of 6 cc/kg of predicted body weight and plateau pressures below 30 cm H2O, remains the cornerstone of ARDS management due to the landmark ARMA trial. Published in 2000, this study challenged the traditional practice of using large tidal volumes (10–15 cc/kg) to normalize blood gases, which often caused stress-induced lung injury. The trial demonstrated that lower tidal volumes significantly reduce mortality, increase ventilator-free days, and decrease non-pulmonary organ failure. While the control group’s high-volume strategy is no longer standard, the trial’s findings established a paradigm shift in critical care. These benefits persist regardless of baseline lung compliance, confirming that minimizing mechanical stretch is essential for protecting both pulmonary and systemic physiological function in critically ill patients.