The mortality rate among patients suffering acute respiratory distress syndrome (ARDS)
remains high despite implementation at clinical centers of the lung protective ventilatory strategies
recommended by the International Guidelines for Management of Severe Sepsis and Septic Shock, 2012.
This suggests that such strategies are still sub-optimal for some ARDS patients. For these patients,
tailored use of ventilator settings should be considered, including: further reduction of tidal volumes,
administration of neuromuscular blocking agents if the patient’s spontaneous breathing is incompatible with mechanical
ventilation, and adjusting positive end-expiratory pressure (PEEP) settings based on transpulmonary pressure levels.