Best ventilator strategy for ARDS is

ARDS can be difficult to distinguish from fluid overload or cardiac failure.Occasionally, conditions may present in a similar way to ARDS but respond to alternative treatments; an example of this might be a glucocoicoid- responsive interstitial pneumonia . Management of ARDS is suppoive, including use of lung-protective mechanical ventilation, inducing a negative fluid balance and treating the underlying cause. Establishing the severity of ARDS is useful, as severe disease will require more proactive management such as prone positioning or extracorporeal membrane oxygenation (ECMO) Berlin definition of ARDS * Onset within 1 week of a known clinical insult, or new or worsening respiratory symptoms * Bilateral opacities on chest X-ray, not fully explained by effusions, lobar/lung collapse or nodules * Respiratory failure not fully explained by cardiac failure or fluid overload. Objective assessment (e.g. by echocardiography) must exclude hydrostatic oedema if no risk factor is present * Impaired oxygenation Ref Davidson edition23rd pg 199_198