A 60-year-old male with severe ARDS is intubated and mechanically ventilated. Despite increasing positive end-expiratory pressure (PEEP) to 15 cmH2O and optimizing tidal volumes, his oxygen saturation remains 88% on 100% FiO2. His plateau pressure is 32 cmH2O. He is already proned. What is the most appropriate next step to improve oxygenation?

The correct answer to the question "A 60-year-old male with severe ARDS is intubated and mechanically ventilated. Despite increasing positive end-expiratory pressure (PEEP) to 15 cmH2O and optimizing tidal volumes, his oxygen saturation remains 88% on 100% FiO2. His plateau pressure is 32 cmH2O. He is already proned. What is the most appropriate next step to improve oxygenation?" is Option C: Consider neuromuscular blockade..

The other options — A) Increase tidal volume to 8 mL/kg ideal body weight., B) Decrease PEEP to 10 cmH2O., D) Administer inhaled nitric oxide. — are incorrect for this USMLE Exam Prep question. As explained above: For severe ARDS refractory to conventional ventilation strategies (optimized PEEP, low tidal volume, proning), neuromuscular blockade can improve oxygenation by reducing oxygen consumption, improving…