Difference between revisions of "Template:Lung Protective Ventilator Settings"

(/* Lung Protective Ventilator SettingsThe Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respirat...)
(Lung Protective Mechanical Ventilation)
 
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===Lung Protective Ventilator Settings<ref>[[EBQ:ARDSnet|The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301-1308.]] </ref>===
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===Lung Protective [[Mechanical Ventilation]]===
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''[[Initial_mechanical_ventilation_settings#Lung_Protective_Strategy|Lung Protective Ventilator Settings]]<ref>[[EBQ:ARDSnet|The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301-1308.]] </ref> should be the default for all intubated patients, unless contraindicated. It has demonstrated mortality benefit for [[ARDS]]-like pulmonary conditions; limits barotrauma and decreases complications of high FiO2<ref>[[EBQ:ARDSnet|ARDSnet]] </ref><ref>O'Brien J. Absorption Atelectasis: Incidence and Clinical Implications. AANA Journal. June 2013. Vol. 81, No. 3.</ref>''
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#'''Mode'''
 
#'''Mode'''
 
#*Volume-assist control
 
#*Volume-assist control
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#*SpO2 BETWEEN 88-95%
 
#*SpO2 BETWEEN 88-95%
 
#*PaO2 BETWEEN 55-80
 
#*PaO2 BETWEEN 55-80
 
 
**Limit barotrauma to healthy area of lung
 
**Increase PEEP to improve oxygenation
 
***High FiO2 can cause absorptive atelectasis<ref>O'Brien J. Absorption Atelectasis: Incidence and Clinical Implications. AANA Journal. June 2013. Vol. 81, No. 3.</ref>
 
***Ardsnet PEEP/FiO2 [http://www.ardsnet.org/files/ventilator_protocol_2008-07.pdf protocol card]<ref>Kallet RH, et al. "Respiratory controversies in the critical care setting. Do the NIH ARDS Clinical Trials Network PEEP/FIO2 tables provide the best evidence-based guide to balancing PEEP and FIO2 settings in adults?" Respiratory Care. 2007. 52(4):461-75.</ref>
 

Latest revision as of 20:33, 2 July 2020

Lung Protective Mechanical Ventilation

Lung Protective Ventilator Settings[1] should be the default for all intubated patients, unless contraindicated. It has demonstrated mortality benefit for ARDS-like pulmonary conditions; limits barotrauma and decreases complications of high FiO2[2][3]

  1. Mode
    • Volume-assist control
  2. Tidal Volume
    • Start 6-8cc/kg predicted body weight[4]
      • Predicted/"ideal" body weight is used because a person's lung parenchyma does not increase in size as the person gains more weight.
    • Titrate down if peak pressure >30 mmHg
  3. Inspiratory Flow Rate (comfort)
    • More comfortable if higher rather than lower
    • Start at 60-80 LPM
  4. Respiratory Rate (titrate for ventilation)
    • Average patient on ventilator requires 120mL/kg/min for eucapnia
    • Start 16-18 breaths/min
    • Maintain pH = 7.30-7.45
  5. FiO2/PEEP (titrate for oxygenation)
    • Move in tandem to achieve:
    • SpO2 BETWEEN 88-95%
    • PaO2 BETWEEN 55-80
  6. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301-1308.
  7. ARDSnet
  8. O'Brien J. Absorption Atelectasis: Incidence and Clinical Implications. AANA Journal. June 2013. Vol. 81, No. 3.
  9. Brower RG, et al. "Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome". The New England Journal of Medicine. 2000. 342(18):1301-1308.