Initial
ventilator settings |
Calcular el peso ideal |
|
Set mode to
volume assist-control |
Set initial tidal
volume to 8 ml/kg PBW |
Reduce tidal volume
to 7 and then to 6 ml/kg over 1-3 hours |
Set initial ventilator rate
≤35 breaths/min to
match baseline minute ventilation |
Subsequent
tidal volume adjustment |
Plateau pressure (Pplat) goal
<30
cmH2O |
Check
inspiratory plateau pressure with 0.5 second inspiratory
pause at least every four hours and after each change in
PEEP or tidal volume. |
If Pplat >30
cmH2O, decrease tidal volume in 1 ml/kg PBW steps to 5
or if necessary to 4 mL/kg PBW. |
If Pplat <25
cmH2O and tidal volume <6 ml/kg, increase tidal
volume by 1 mL/kg PBW until Pplat >25 cmH2O or tidal
volume = 6 ml/kg. |
If breath stacking
(autoPEEP) or severe dyspnea occurs, tidal volume may be
increased to 7 or 8 mL/kg PBW if Pplat remains <30 cmH2O. |
Arterial
oxygenation and PEEP |
Oxygenation goal PaO2 55-80
mmHg or SpO2 88-95 percent |
Use these FiO2/PEEP
combinations to achieve oxygenation goal: |
FiO2 |
0.3 |
0.4 |
0.5 |
0.6 |
0.7 |
0.8 |
0.9 |
1.0 |
PEEP |
5 |
5-8 |
8-10 |
10 |
10-14 |
14 |
14-18 |
18-22 |
PEEP should be applied
starting with the minimum value for a given
FiO2. |