ARDS ventilation protocol

Stage 1

• Calculate predicted body weight (PDF)
  • Men = 50 + (2.3 x (height in inches - 60))
  • Women = 45.5 + (2.3 x (height in inches - 60))
• Set volume assist/control
  • Tidal volume (VT) to 8 ml/kg PBW
  • PEEP of 5 cmH2O
  • Lowest FIO2 to target SpO2 88-95% or PsO2 55-80 mmHg
  • I:E ratio 1:1 to 1:13
• Decrease VT by 1ml/kg every 2h until reaching 6 ml/kg

Stage 2

• Once reached VT = 6 ml/kg, measure a plateau pressure (Ppl)
• If Ppl >30 cmH2O, decrease VT by 1 ml/kg until Ppl < 30 or VT is 4 ml/kg

Stage 3

• Monitor ABG for acidosis
• If pH is 7.15-7.3, increase the resp rate until pH >7.3 to a maximum of 45 breaths/min
• If pH <7.15, increase RR to 35, followed by increasing VT by 1 ml/kg until pH >7.15

Goals

• VT = 6 ml/kg PBW
• Ppl ≤ 30 cm H2O
• SpO2 = 88-95%
• pH = 7.3-7.45