Lung Protective Ventilation

Protocol for lung protective ventilation

1) Select assist-control mode and FiO2 = 100%
2) Select initial tidal volume (Vt) at 8ml/kg using the patient's predicted body weight (PBW)
Males : PBW = 50 + [2.3 x (height (in) - 60)]
Females: PBW = 45.5 + [2.3 x (height (in) - 60)]
3) Select respiratory rate to achieve pre-ventilator minute ventilation, but do not exceed a  RR of 35/min
4) Add PEEP at 5-7 cm H20
5) Reduce Vt by 1ml/kg every 2 hours until Vt is 6ml/kg
6) Adjust Fi02 and PEEP to keep PaO2  > 55 or SaO2 > 88%
7) When Vt is 6ml/kg, measure plateau pressure (Ppl) and arterial PCO2 and pH
If Ppl > 30cm, decrease TV in 1ml/kg steps until Ppk less than 30 cm H20 or 4ml/kg
If pH 7.15 - 7.3, increase RR until pH > 7.3 or RR = 33/min
If pH < 7.15, increase RR to 35 and increase TV at 1ml/kg increments until pH > 7.15

Explanation in a separate post to come...

Thanks to Dr. Amina Merchant for this post.