Ventilator Management

Recommendations for management of vented patients in ICU

Lung protective ventilation

  • Initial mode of ventilation: Assist control PRVC
  • Tidal volume: 6 mL/kg Predicted Body Weight (calculate this from height and gender)
    • Male patients: 50 + 2.3 [height (inches) – 60]
    • Female patients: 45.5 + 2.3 [height (inches) – 60]
  • PEEP 10 cm H2O: Monitor hemodynamics with increasing PEEP
  • Respiratory rate: 20-25
  • Consider patients’ pre-intubation respiratory rate
  • Goal: Limit over-distention of alveoli and ensure adequate oxygenation and ventilation. Over-distention causes inflammation, organ dysfunction, decreased venous return, and worsens ARDS.

Source:

American Heart Association: Oxygenation and Ventilation of COVID-19 Patients Module 4: Ventilation Management 

Last Updated 5 months ago

Oxygenation

  • PaO2 >60 / SpO2 88-98%
  • FIO2 to maintain a SpO2 of 88-98%
    • FIO2 <0.6
    • Try to avoid 100% oxygen, which favors de-nitrogenation atelectasis
    • Lower FIO2 of 0.7-0.9 may not drastically change oxygenation due to high levels of shunt

Ventilation

  • Tidal volumes of 4-8 mL/kg of PBW
  • pH 7.25-7.42
  • PaCO2 40-65 / end-tidal carbon dioxide (ETCO2) 35-60 mm Hg

ARDSNET Protocol

Sources:

American Heart Association: Oxygenation and Ventilation of COVID-19 Patients Module 4: Ventilation Management 

Last Updated 5 months ago
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