ARDS is one of the more complex syndromes we manage in critical care. More than just pulmonary edema, we are battling stiff lungs, refractory hypoxemia, rising pressures, and frequently making decisions that can either protect the lung or make things worse.

In this episode, I’m joined by respiratory therapist Melody Bishop for a deep dive into ARDS ventilator management through the lens of physiology, evidence, and real bedside practice. We break down what’s actually happening in the lung, why some long-held practices have fallen out of favor, and how nurses and RTs can work together to make more precise, lung-protective decisions.

If ARDS has ever felt like guesswork, this episode will help it make sense.

Topics discussed in this episode:

What ARDS looks like at the alveolar level and why surfactant loss changes everything
How inflammation leads to stiff lungs, poor compliance, and refractory hypoxemia
Why lung-protective ventilation is about avoiding harm, not chasing perfect numbers
Moving beyond tidal volume: how driving pressure reframes vent management
How RTs use compliance trends to judge whether lungs are improving or failing
PEEP selection: why tables are a guide, not the final answer
The physiology behind proning and why it’s one of the few ARDS interventions that saves lives
Why recruitment maneuvers fell out of favor (and what works instead)
What nurses should be watching on the ventilator to catch deterioration early

Connect with Melody and download her free book:

https://melodybishoprt.com/

Mentioned in this episode:

Rapid Response Academy Winter 2026 Cohort

https://www.rapidresponseandrescue.com/rra

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