Effectiveness of Lung-Protective Ventilation Strategies on Clinical Outcomes in Adult Patients with Acute Respiratory Distress Syndrome: A Systematic Review

Abstract

Acute Respiratory Distress Syndrome (ARDS) is a severe form of hypoxemic respiratory failure frequently encountered in intensive care units and is associated with high morbidity and mortality. Mechanical Ventilation remains a cornerstone of ARDS management; however, inappropriate ventilatory settings can exacerbate lung injury through ventilator-induced lung injury. Lung-protective ventilation strategies have been introduced to minimize alveolar overdistension and cyclic atelectasis. This systematic review evaluates the effectiveness of lung-protective mechanical Ventilation compared with conventional Ventilation in adult ICU patients with ARDS. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science for studies published between 2010 and 2025, in accordance with PRISMA 2020 guidelines. Randomized controlled trials and observational studies reporting mortality, ventilator-free days, duration of mechanical Ventilation, or ICU length of stay were included. Following screening and quality assessment, 28 studies met the inclusion criteria. Of the included studies, 15 were randomized controlled trials and 13 observational studies, with risk of bias assessed using the Cochrane Risk of Bias Tool and Newcastle–Ottawa Scale. The findings demonstrate that lung-protective Ventilation is consistently associated with reduced mortality, increased ventilator-free days, and shorter mechanical Ventilation duration. At the same time, effects on ICU length of stay were variable. Overall, the evidence supports lung-protective Ventilation as a standard of care in the management of adult ARDS.