ARDS Ventilation Strategy
ARDSNet PEEP/FiO₂ Table Explained: Low vs High PEEP Strategy
The ARDSNet PEEP/FiO₂ table is one of the most commonly used bedside frameworks for oxygenation support in acute respiratory distress syndrome. It helps clinicians pair PEEP and FiO₂ in a more structured way instead of making isolated changes without a strategy.
If you want the full protective ventilation context, pair this guide with our ARDSNet Calculator, ARDSNet Protocol Explained, Permissive Hypercapnia Explained, and the Desired VE Calculator. For oxygenation severity, also review our P/F Ratio guide and A–a Gradient guide.
What Is the ARDSNet PEEP/FiO₂ Table?
The ARDSNet PEEP/FiO₂ table is a protocol-based oxygenation ladder that pairs an FiO₂ level with a suggested PEEP level. Instead of adjusting oxygen support randomly, the table gives clinicians a structured way to move between oxygen concentration and end-expiratory pressure while staying inside a lung-protective ventilation framework.
It is not meant to replace clinical judgment. It is meant to standardize oxygenation support in ARDS and help teams avoid drifting into inconsistent ventilator management.
ARDSNet Oxygenation Goals
The ARDSNet framework usually targets an oxygenation range of roughly PaO₂ 55–80 mmHgor SpO₂ 88–95%. The point is not to create a perfectly normal PaO₂ at all costs. The goal is to provide adequate oxygenation while preserving safe ventilation.
- Avoid reflexively chasing very high PaO₂ values with excessive FiO₂
- Use PEEP and FiO₂ together rather than making one-off isolated changes
- Interpret oxygenation alongside plateau pressure, compliance, and hemodynamics
To classify oxygenation severity quickly, use the P/F Ratio & Oxygenation Index tool.
Low PEEP vs High PEEP Strategy
Low PEEP / Higher FiO₂ Approach
This approach uses more oxygen concentration with relatively lower PEEP escalation. It can be easier to tolerate in some patients and is commonly used when clinicians want a simpler starting path for oxygenation support.
High PEEP / Lower FiO₂ Approach
This approach leans harder on PEEP in order to reduce FiO₂ exposure. It may make sense in selected ARDS patients, but it also raises the importance of hemodynamics, compliance, and overdistension risk.
The key idea is that neither table should be treated like a blind recipe. Both must be interpreted in the context of the patient’s recruitability, blood pressure, plateau pressure, and overall ARDS trajectory.
ARDSNet PEEP/FiO₂ Tables
Low PEEP / Higher FiO₂ Table
| FiO₂ | PEEP (cm H₂O) |
|---|---|
| 0.30 | 5 |
| 0.40 | 5 |
| 0.40 | 8 |
| 0.50 | 8 |
| 0.50 | 10 |
| 0.60 | 10 |
| 0.70 | 10 |
| 0.70 | 12 |
| 0.80 | 14 |
| 0.90 | 14 |
| 1.00 | 18–24 |
High PEEP / Lower FiO₂ Table
| FiO₂ | PEEP (cm H₂O) |
|---|---|
| 0.30 | 5 |
| 0.30 | 8 |
| 0.30 | 10 |
| 0.30 | 12 |
| 0.30 | 14 |
| 0.40 | 14 |
| 0.40 | 16 |
| 0.50 | 16 |
| 0.50 | 18 |
| 0.60 | 20 |
| 0.80 | 22 |
| 0.90 | 22 |
| 1.00 | 24 |
Want to apply this instantly? Use the ARDSNet Calculator to compare a patient’s current PEEP/FiO₂ combination against the protocol.
How to Use the Table at the Bedside
- Start with the patient’s current FiO₂ and PEEP.
- Check whether the pairing resembles a low-PEEP or high-PEEP path.
- Match the oxygenation goal: PaO₂ about 55–80 or SpO₂ about 88–95%.
- Reassess plateau pressure, hemodynamics, and lung mechanics after changes.
- Do not forget the larger ARDS strategy: low tidal volume, pressure awareness, and tolerance of permissive hypercapnia when appropriate.
This is why the table works best when paired with permissive hypercapnia guidance and the Desired VE calculator rather than being used in isolation.
Common Mistakes with the PEEP/FiO₂ Table
- Treating the table like a rigid script instead of a structured guideline
- Increasing PEEP without reassessing blood pressure and overdistension risk
- Ignoring plateau pressure and driving pressure while chasing oxygenation
- Using oxygen numbers without evaluating the full blood gas and clinical picture
If you need to interpret the acid-base side of ventilator changes, review our ABG Interpretation guide and ABG Analyzer.
Related Guides
FAQ
What is the ARDSNet PEEP/FiO₂ table?
It is a protocol-based table that pairs PEEP and FiO₂ values to help clinicians manage oxygenation more consistently in ARDS.
What oxygenation target does ARDSNet use?
ARDSNet commonly targets a PaO₂ of about 55–80 mmHg or SpO₂ of about 88–95%.
When would clinicians use the high PEEP table?
The high PEEP table may be used when clinicians want a higher PEEP and lower FiO₂ oxygenation strategy, depending on recruitability, hemodynamics, and the overall ARDS picture.
What should I read next?
Continue with ARDSNet Protocol Explained and Permissive Hypercapnia Explained.
Bottom Line
The ARDSNet PEEP/FiO₂ table is one of the most useful oxygenation frameworks in ICU ventilation. It works best when used as part of a bigger protective strategy that also includes low tidal volume ventilation, plateau pressure awareness, oxygenation targets, and permissive hypercapnia when clinically appropriate.