Initial ventilator settings | ||||||||
Calculate PBW | ||||||||
Male = | 50 + 2.3 [height (inches) – 60] or | |||||||
50 + 0.91 [height (cm) – 152.4] | ||||||||
Female = | 45.5 + 2.3 [height (inches) – 60] or | |||||||
45.5 + 0.91 [height (cm) – 152.4] | ||||||||
Set mode to volume assist-control | ||||||||
Set initial tidal volume to 6 mL/kg PBW | ||||||||
Set initial ventilator rate ≤35 breaths/minute to match baseline minute ventilation (to avoid hypercapnia) | ||||||||
Subsequent tidal volume adjustment | ||||||||
Pplat goal: ≤30 cm H2O | ||||||||
Check inspiratory Pplat with 0.5 second inspiratory pause at least every 4 hours and after each change in PEEP or tidal volume. | ||||||||
If Pplat >30 cm H2O, decrease tidal volume in 1 mL/kg PBW steps to 5 or if necessary to 4 mL/kg PBW. | ||||||||
If Pplat <25 cm H2O and tidal volume <6 mL/kg, increase tidal volume by 1 mL/kg PBW until Pplat >25 cm H2O 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 cm H2O. | ||||||||
Arterial oxygenation and PEEP | ||||||||
Oxygenation goal: PaO2 55 to 80 mmHg or SpO2 88 to 95% | ||||||||
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 |
PEEP | 5 | 5 to 8 | 8 to 10 | 10 | 10 to 14 | 14 | 14 to 18 | 18 to 24 |
PEEP should be applied starting with the minimum value for a given FiO2. |
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