Treatment of Acute Respiratory Failure in Acute Respiratory Distress Syndrome (ARDS) with PaO2/FiO2 Ratio ≤ 300

This protocol targets acute respiratory failure occurring within the context of acute respiratory distress syndrome (ARDS), defined by a PaO2/FiO2 ratio at or below 300 under PEEP or CPAP of at least 5 cmH₂O, with bilateral pulmonary involvement and acute onset.

Diagnostic Criteria (Berlin Definition)

PaO2/FiO2 ratio ≤ 300 under PEEP/CPAP ≥ 5 cmH₂O
Acute onset within one week
Bilateral shadows on chest imaging
Respiratory failure not fully explained by cardiac failure or fluid overload alone

Treatment Approach

Management involves invasive positive pressure ventilation using a lung-protective strategy — with low tidal volume ventilation as a central component. In moderate-to-severe ARDS, additional ventilatory and positional interventions are incorporated as part of the structured regimen.

The complete sequencing, specific interventions, and escalation criteria are available in the full protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1186/s40560-023-00658-3

The clinical diagnosis of ARDS is currently based on the Berlin definition: (1) PaO2/FIO2 ratio ≤ 300 under positive end-expiratory pressure (PEEP)/continuous positive airway pressure (CPAP) ≥ 5 cmHO2; (2) acute onset within a week; (3) bilateral shadows in the lung fields, and (4) respiratory failure that cannot be explained by cardiac failure or excess fluid alone.

Low tidal volume ventilation is now weakly recommended for all patients with ARF and strongly recommended for patients with ARDS.

Prone position ventilation with prolonged hours is weakly to strongly recommended for moderate-to-severe ARDS.

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