Ventilation (Strategies): Difference between revisions
m (moved Vent (ARDS) to Ventilator Management) |
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== Lung Injury Strategy == | |||
=== Background === | |||
*Ok for all pts except for obstructed | |||
=== Settings === | |||
*1. Mode | |||
**Assist control | |||
*2. Tidal Volume (lung protection) | |||
**Start 6-8cc/kg ideal body wt | |||
***Titrate down if peak pressure >30 | |||
*3. Inspiratory Flow Rate (comfort) | |||
**More comfortable if higher rather than lower | |||
**Start at 60-80 LPM | |||
*4. Respiratory Rate (CO2) | |||
**Avg pt on ventilator requires 120mL/kg/min for eucapnia | |||
**Start 16-18 breaths/min | |||
*5. FiO2/PEEP (O2) | |||
**Move in tandem to achieve: | |||
***SpO2 BETWEEN 88-95% | |||
***PaO2 BETWEEN 55-80 | |||
{| border="1" cellspacing="1" cellpadding="1" style="width: 500px; " | |||
|- | |||
| FiO2 | |||
| 0.3 | |||
| 0.4 | |||
| 0.4 | |||
| 0.5 | |||
| 0.5 | |||
| 0.6 | |||
| 0.7 | |||
| 0.7 | |||
| 0.7 | |||
| 0.8 | |||
| 0.9 | |||
| 0.9 | |||
| 0.9 | |||
| 1.0 | |||
| 1.0 | |||
| 1.0 | |||
|- | |||
| PEEP | |||
| 5 | |||
| 5 | |||
| 8 | |||
| 8 | |||
| 10 | |||
| 10 | |||
| 10 | |||
| 12 | |||
| 14 | |||
| 14 | |||
| 14 | |||
| 16 | |||
| 18 | |||
| 20 | |||
| 22 | |||
| 24 | |||
|} | |||
Inclusion criteria: | Inclusion criteria: | ||
ARDS defined as PaO2/FiO2 ratio <300, bilateral alveolar infiltrates on CXR, no evidence of CHF | ARDS defined as PaO2/FiO2 ratio <300, bilateral alveolar infiltrates on CXR, no evidence of CHF | ||
Treatment: | Treatment: | ||
| Line 11: | Line 82: | ||
2) Increased PEEP with decreased FiO2--> | 2) Increased PEEP with decreased FiO2--> | ||
) | |||
Adjust to: | Adjust to: | ||
| Line 37: | Line 94: | ||
2) PaO2 = 55-80 (or SaO2 = 88-95%) | 2) PaO2 = 55-80 (or SaO2 = 88-95%) | ||
Outcome: decreased mortality & #days on the ventilator | Outcome: decreased mortality & #days on the ventilator | ||
2/2/06 DONALDSON (adapted from Lampe; NEJM May 200?) | 2/2/06 DONALDSON (adapted from Lampe; NEJM May 200?) | ||
<br/>[[Category:Pulm]] <br/><br/> | |||
[[Category:Pulm]] | |||
Revision as of 02:47, 23 May 2011
Lung Injury Strategy
Background
- Ok for all pts except for obstructed
Settings
- 1. Mode
- Assist control
- 2. Tidal Volume (lung protection)
- Start 6-8cc/kg ideal body wt
- Titrate down if peak pressure >30
- Start 6-8cc/kg ideal body wt
- 3. Inspiratory Flow Rate (comfort)
- More comfortable if higher rather than lower
- Start at 60-80 LPM
- 4. Respiratory Rate (CO2)
- Avg pt on ventilator requires 120mL/kg/min for eucapnia
- Start 16-18 breaths/min
- 5. FiO2/PEEP (O2)
- Move in tandem to achieve:
- SpO2 BETWEEN 88-95%
- PaO2 BETWEEN 55-80
- Move in tandem to achieve:
| FiO2 | 0.3 | 0.4 | 0.4 | 0.5 | 0.5 | 0.6 | 0.7 | 0.7 | 0.7 | 0.8 | 0.9 | 0.9 | 0.9 | 1.0 | 1.0 | 1.0 |
| PEEP | 5 | 5 | 8 | 8 | 10 | 10 | 10 | 12 | 14 | 14 | 14 | 16 | 18 | 20 | 22 | 24 |
Inclusion criteria:
ARDS defined as PaO2/FiO2 ratio <300, bilateral alveolar infiltrates on CXR, no evidence of CHF
Treatment:
1) TV 6cc/kg ideal body weight
2) Increased PEEP with decreased FiO2-->
)
Adjust to:
1) pH = 7.3-7.45 adjust rate (6-35) prn
2) PaO2 = 55-80 (or SaO2 = 88-95%)
Outcome: decreased mortality & #days on the ventilator
2/2/06 DONALDSON (adapted from Lampe; NEJM May 200?)