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ARDS net

ARDS net. ARDSnet Ventilatory Strategy. First Stage Calculate predicted body weight - 0.91x(height in cm-152.4)+50/45.5 Set Mode - VC/AC Set initial TV to 8 ml/Kg PBW Add PEEP of 5-7 cm H2O Reduce TV by 1 ml/kg every 2 hours until TV = 6 ml/Kg PBW. ARDSnet Ventilatory Strategy.

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ARDS net

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  1. ARDS net

  2. ARDSnet Ventilatory Strategy First Stage • Calculate predicted body weight - 0.91x(height in cm-152.4)+50/45.5 • Set Mode - VC/AC • Set initial TV to 8 ml/Kg PBW • Add PEEP of 5-7 cm H2O • Reduce TV by 1 ml/kg every 2 hours until TV = 6 ml/Kg PBW

  3. ARDSnet Ventilatory Strategy Second Stage • When TV 6 ml/kg measure inspiratory plateau pressure with 0.5s pause • Target Pplat < 30 cm H2O • Measure Pplat 4hourly & after every change in PEEP or TV • If Pplat > 30 reduce TV 1 ml/kg until Pplat < 30 or TV 4ml/kg • Pplat < 25 & TV < 6ml/Kg increase TV

  4. ARDSnet Ventilatory Strategy Third Stage • Monitor ABG for respiratory acidosis • Target pH = 7.3 – 7.45 • If pH 7.15 – 7.30 increase RR until pH > 7.30 or RR > 35/min • If pH < 7.15 increase RR to 35 • If pH still < 7.15 increase TV at 1 ml/kg increments till pH > 7.15 • Do not increase RR if PCO2 < 25 • If pH < 7.30 & RR 35/min consider Bicarbinf • pH > 7.45 & patient not triggering decrease RR (> 6/min)

  5. ARDSnet Ventilatory Strategy • Oxygenation goal: PaO2 55 - 80 mmHg/ SpO2 88 - 95% • FiO2 <70% • Allowable combination of FiO2 and PEEP: FiO2 0.3 0.4 0.4 0.5 0.5 0.6 0.7 0.7 0.7 0.8 PEEP 5 5 8 8 10 10 10 12 14 14 FiO2 0.9 0.9 0.9 1.0 1.0 1.0 1.0 PEEP 14 16 18 18 20 22 24

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