•  Do not exceed VT 8 mL/kg PBW in ARDS — higher volumes cause volutrauma regardless of pressure

•  Plateau pressure above 30 cmH2O should trigger immediate ventilator adjustment or senior review

•  Do not allow FiO2 >0.6 for prolonged periods — wean O2 as soon as SpO2 target is met     

•  Permissive hypercapnia (accepting PaCO2 up to 8–10 kPa) is preferable to unsafe pressures or volumes in ARDS