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Tag: Redirect target changed |
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| == Lung Injury Strategy ==
| | #REDIRECT[[Initial mechanical ventilation settings]] |
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| === Background ===
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| *Ok for all pts except for obstructed
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| === Settings ===
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| *1. Mode
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| **Assist control
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| *2. Tidal Volume (lung protection)
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| **Start 6-8cc/kg ideal body wt
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| ***Titrate down if peak pressure >30
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| *3. Inspiratory Flow Rate (comfort)
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| **More comfortable if higher rather than lower
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| **Start at 60-80 LPM
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| *4. Respiratory Rate (CO2)
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| **Avg pt on ventilator requires 120mL/kg/min for eucapnia
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| **Start 16-18 breaths/min
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| *5. FiO2/PEEP (O2)
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| **Move in tandem to achieve:
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| ***SpO2 BETWEEN 88-95%
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| ***PaO2 BETWEEN 55-80
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| {| border="1" cellspacing="1" cellpadding="1" style="width: 500px; "
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| |-
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| | FiO2
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| | 0.3
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| | 0.4
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| | 0.4
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| | 0.5
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| | 0.5
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| | 0.6
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| | 0.7
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| | 0.7
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| | 0.7
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| | 0.8
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| | 0.9
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| | 0.9
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| | 0.9
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| | 1.0
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| | 1.0
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| | 1.0
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| |-
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| | PEEP
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| | 5
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| | 5
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| | 8
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| | 8
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| | 10
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| | 10
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| | 10
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| | 12
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| | 14
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| | 14
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| | 14
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| | 16
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| | 18
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| | 20
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| | 22
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| | 24
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| |}
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| Inclusion criteria:
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| ARDS defined as PaO2/FiO2 ratio <300, bilateral alveolar infiltrates on CXR, no evidence of CHF
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| Treatment:
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| 1) TV 6cc/kg ideal body weight
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| 2) Increased PEEP with decreased FiO2-->
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| )
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| Adjust to:
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| 1) pH = 7.3-7.45 adjust rate (6-35) prn
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| 2) PaO2 = 55-80 (or SaO2 = 88-95%)
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| Outcome: decreased mortality & #days on the ventilator
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| 2/2/06 DONALDSON (adapted from Lampe; NEJM May 200?)
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| <br/>[[Category:Pulm]] <br/><br/>
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