What is the ARDSNet protocol?

The ARDSNet protocol is a lung-protective ventilation strategy that uses low tidal volume ventilation, limits plateau pressure, and applies structured PEEP and FiO2 adjustments to reduce ventilator-induced lung injury.

What tidal volume is used in ARDSNet?

ARDSNet recommends starting with tidal volumes around 6 mL/kg of predicted body weight and adjusting down to as low as 4 mL/kg if needed to maintain safe plateau pressures.

What is permissive hypercapnia in ARDS?

Permissive hypercapnia is a strategy that allows higher levels of PaCO2 in order to maintain lung-protective ventilation settings, prioritizing reduced lung injury over normal CO2 levels.

Why is plateau pressure limited in ARDSNet?

Plateau pressure is limited to reduce the risk of ventilator-induced lung injury by preventing excessive alveolar stretch and overdistension.

← Back to blog ARDSNet protocol ventilator settings

ARDSNet Protocol Explained: Ventilator Settings, Tidal Volume Strategy, and PEEP Guide

The ARDSNet protocol is the foundation of modern ARDS ventilator management. This guide breaks down low tidal volume ventilation, PEEP strategy, and permissive hypercapnia into practical bedside steps.

Looking for a quick calculator? Use the ARDSNet Protocol Tool to calculate tidal volume and ventilator settings instantly.

Use these tools alongside this guide:

ARDSNet Calculator Desired VE Calculator PaCO₂ Calculator

Core ARDSNet Principles

Low tidal volume ventilation (≈ 6 mL/kg PBW)
Limit plateau pressure (≤ 30 cmH₂O)
Use PEEP/FiO₂ strategy for oxygenation
Accept permissive hypercapnia when needed

Low Tidal Volume Strategy

Start with 6 mL/kg predicted body weight. Reduce further (down to 4 mL/kg) if plateau pressure exceeds target.

PEEP & Oxygenation

Use a structured PEEP/FiO₂ table to balance oxygenation and lung protection. Avoid chasing saturation at the expense of overdistension.

Permissive Hypercapnia

ARDSNet allows higher PaCO₂ to maintain lung-protective settings. Focus on pH tolerance rather than normalizing CO₂.

→ Full Permissive Hypercapnia Guide

Bottom Line

ARDSNet is about lung protection first. Tidal volume, pressure limits, and controlled oxygenation strategies work together to reduce ventilator-induced lung injury.