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:
Core ARDSNet Principles
- Low tidal volume ventilation (≈ 6 mL/kg PBW)
- Limit plateau pressure (≤ 30 cmH₂O)
- Use a structured 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. Use the ARDSNet calculator to generate bedside tidal volume targets quickly, and pair it with the IBW calculator if you want a separate predicted body weight check.
PEEP & Oxygenation
Use a structured PEEP/FiO₂ table to balance oxygenation and lung protection. Avoid chasing saturation at the expense of overdistension. For a deeper breakdown of low-PEEP vs high-PEEP strategy, read our ARDSNet PEEP/FiO₂ table explanation and cross-check oxygenation severity with the P/F ratio tool.
Permissive Hypercapnia
ARDSNet allows higher PaCO₂ to maintain lung-protective settings. Focus on pH tolerance rather than normalizing CO₂. For a deeper review, see the permissive hypercapnia explained guide and the more practical permissive hypercapnia ICU guide. If you are adjusting ventilation to target a different PaCO₂, use the Desired VE calculator.
Bottom Line
ARDSNet is about lung protection first. Tidal volume, pressure limits, and controlled oxygenation strategies work together to reduce ventilator-induced lung injury. Use the ARDSNet calculator for bedside implementation, the PEEP/FiO₂ table guide for oxygenation decisions, and the permissive hypercapnia guide when CO₂ tolerance becomes part of the ARDS strategy.