Table 1.

Ventilator and non-ventilator strategies during controlled mechanical ventilation.

STRATEGY	TARGET	RATIONALE-CONSIDERATIONS	Quality of Evidence
Ventilator strategies
FiO2	SaO2	To avoid complications related to either hyperoxia or hypoxia	Controversial
Tidal volume	≤6 mL/kg/PBW	Low tidal volume improves outcome in patients with ARDS.	High
	Pplat < 30 cmH2O	Pplat as a surrogate of stress	Low
	PL at end-inspiration < 18–20 cmH2O	The stress in the lungs at a given lung volume. Consider in patients with suspected high chest wall elastance	Low
	ΔP < 14 cmH2O	Individualizes VT to functional lung size (Crs). The strongest predictor of mortality in recent studies.	High
PEEP	Individualizedbased on assessment of lung recruitability	Improves inhomogeneity by recruiting closed alveoli and preventing cyclic collapseConsider higher PEEP in patients with high lung recruitability	High
	PL at end -expiration > 0 cmH2O	Considered in patients with suspected high pleural pressure	High
Non-ventilator strategies
Prone position	Up to 36 h/sessions	Increases lung homogeneity and size of aerated lung; improves V/Q inaqualities and decrease shuntConsider proning early in the course of mechanical ventilation in patients with moderate to severe ARDS	High
Neuromuscular blockade	<48 h infusion (Cisatracurium)	Considered in patients with severe hypoxemia, significant patient–ventilator asynchrony that restrains lung-protective ventilation, and in patients with markedly high respiratory drive despite deep sedation	Controversial

PBW = predicted body weight; Pplat = end-inspiratory pressure; PL = Transpulmonary pressure; ΔP = Driving pressure; Crs = Respiratory system compliance.