Ventilation (Strategies)

Lung Injury Strategy

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

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?)

Authors: