Lung-Protective Ventilation in Acute Respiratory Distress Syndrome and Non-acute Respiratory Distress Syndrome Patients: A Critical Appraisal of Its Benefits

Mechanical ventilation is essential in the care of critically ill patients, yet it carries a considerable risk of causing lung injury, particularly in those with acute respiratory distress syndrome (ARDS). Lung-protective ventilation strategies, most notably the use of low tidal volumes and carefully titrated positive end-expiratory pressure, have been widely recommended in patients with ARDS. Whether such strategies offer similar benefit in non-ARDS patients remains uncertain. Recent randomized trials have failed to demonstrate clear advantages in non-ARDS populations and, in some cases, have suggested potential harm. Recent evidence has increasingly questioned whether lung-protective ventilation confers consistent and meaningful benefits across all ARDS patients. These concerns have led to growing interest in tailoring ventilator settings to the individual patient and underlying condition, rather than universally applying a uniform ventilation strategy. This narrative review critically appraises the randomized clinical trial evidence for lung-protective ventilation in ARDS and non-ARDS patients.