Recommendation:We recommend the use of low tidal volume at 6-8 mL/kg (predicted body weight: PBW) in adult patients with ARDS. (GRADE 1B, STRONG RECOMMENDATION / MODERATE-QUALITY EVIDENCE)

● Supplementary conditions: Tidal volume is calculated based on PBW (Male:50+0.91 x [Height(cm) – 152.4], Female: 45.5+0.9x[Height(cm) – 152.4]) rather than actual body weight. When a lung protective ventilation strategy is applied, a tidal volume equal to or less than 10mL/kg PBW is considered beneficial. However, the optimal tidal volume still remains to be determined. Of the RCTs analyzed in this review, the actual tidal volume delivered in the lung protective strategy group was 6.2-7.6 mL/kg. Therefore, we recommend a tidal volume of 6-8 mL/kg PBW. In case of an excessive spontaneous breathing effort, the actual tidal volume may sometimes exceed the targeted tidal volume. To prevent this, respiratory parameters such as driving pressure or trans-pulmonary pressure may need to be used as monitoring tools to determine an appropriate tidal volume.