The management of patients with ARDS should safely support gas exchange without further injuring the patient’s lungs.17 In fact, using a lung-protective ventilator strategy in all intubated patients appears to improve clinical outcomes.18–20 Providers must also recognize that there are also some limitations imposed by the transport ventilators and that the patient’s PaO2 will always decrease during aeromedical transport.21,22

In patients with ARDS, the goal is to limit barotrauma (PPLAT≤30 cm H2O or peak inspiratory pressure, PIP≤35 cm H2O if PPLAT cannot be measured), volutrauma (VT 6-8 mL/kg PBW) and atelectrauma (moderate to high PEEP).17 Goals should include an SpO2≥88-95% and a pH≥7.3 (in traumatic brain injury, this pH goal should be met with the PaCO2 maintained at 35-40 mm Hg).

Early consultation with an intensivist is encouraged for all patients with moderate to severe ARDS. Military physician-to-physician consultation can be obtained by contacting Landstuhl Regional Medical Center (LRMC) at DSN 314-486-7141 or San Antonio Military Medical Center (SAMMC) at DSN 312-429-BURN (2876).

For Role 3 patient management, see Appendix A.