Mechanical ventilation protocols

Standard Ventilation

Physiological targets:
- Oxygenation: SpO2 greater than 90% (unless otherwise directed by the attending physician)
- Acid-base: pH greater than 7.3
Ventilation limits:
- Tidal volume (VT): 6 to 8 mL/kg predicted body weight
- Plateau airway pressure (Pplat): less than 30 cm H2O
- Respiratory rate (RR): less than 30 breaths per minute
PEEP and FIO2:
- PEEP is titrated according to the Standard PEEP-FIO2 TABLE

Mode: PCV is the default mode, unless otherwise directed by the attending physician.
Physiological targets:
- Oxygenation: SpO2 from 88 to 93% (unless otherwise directed by the attending physician)
- Acid-base: pH greater than 7.25 (unless otherwise directed by the attending physician)
Ventilation limits:
- Tidal volume (VT): maximum 6 mL/kg predicted body weight
- Plateau airway pressure (Pplat): less than 30 cm H2O
- Respiratory rate (RR): less than 40 breaths per minute
PEEP and FIO2:
- The PEEP and FiO2 are titrated according to the ARDS PEEP-FIO2 Table

Mode: PCV is the default mode, unless otherwise directed by the attending physician.
Physiological targets:
- Oxygenation: SpO2 from 92 to 98% (unless otherwise directed by the attending physician)
- Acid-base: PaCO2 from 35 to 40 mmHg, EtCO2 from 30 to 35 mmHg (unless otherwise directed by the attending physician)
Ventilation limits:
- Tidal volume (VT): 6 to 8 mL/kg predicted body weight
- Plateau airway pressure (Pplat): less than 30 cm H2O
- Respiratory rate (RR): less than 30 breaths per minute
PEEP and FIO2:
- The PEEP is titrated according to the Low PEEP-FIO2 Table
Note: End-tidal CO2 monitoring is mandatory in this ventilation strategy. On initiating end-tidal CO2 monitoring, an arterial blood gas must be sent to document the gradient between the arterial and end-tidal CO2 for ongoing monitoring purposes