Just need it to be in Protocol format, you got the points in the article and the guidelines.
Michelle_Michy
2020072104360320200501015449ardsnet.pdf
IN C
LU S
IO N
C R
IT E
R IA
: A
cu te
o n
se t
o f
1.
Pa O
2/ Fi
O 2 ≤
30 0
(c or
re ct
ed f
or a
lt itu
de )
2.
B ila
te ra
l ( pa
tc hy
, di
ff u se
, or
h om
og en
eo u s)
in fil
tr at
es c
on si
st en
t w
it h
pu lm
on ar
y ed
em a
3.
N o
cl in
ic al
e vi
de nc
e of
le ft
a tr
ia l h
yp er
te ns
io n
P A
R T
I :
V E
N T
IL A
T O
R S
E T
U P
A N
D A
D JU
S T
M E
N T
1.
C al
cu la
te p
re di
ct ed
b od
y w
ei gh
t (P
B W
) M
a le
s =
5 0
+ 2
.3 [
he ig
ht (
in ch
es )
- 60
] F e
m a
le s
= 4
5. 5
+ 2
.3 [
he ig
ht (
in ch
es )
-6 0]
2.
Se
le ct
a n y
ve n ti la
to r
m od
e 3.
Se
t ve
nt ila
to r
se tt
in g s
to a
ch ie
ve in
it ia
l V T =
8 m
l/ kg
P B W
4.
R ed
uc e
V T b
y 1
m l/ kg
a t
in te
rv al
s ≤
2 ho
ur s
un ti l V
T =
6 m
l/ kg
P B W
. 5.
Se
t in
it ia
l r at
e to
a pp
ro xi
m at
e ba
se lin
e m
in u te
v en
ti la
tio n
(n ot
> 3
5 bp
m ).
6.
A dj
us t
V T a
nd R
R t
o ac
hi ev
e pH
a nd
p la
te au
p re
ss ur
e go
al s
be lo
w .
AA
RR DD
SS nn
ee tt
O X
Y G
E N
A T
IO N
G O
A L:
P a
O 2 5
5 -8
0 m
m H
g o
r S
p O
2 8
8 -9
5 %
U
se a
m in
im um
P EE
P of
5 c
m H
2O . C on
si de
r u se
o f
in cr
em en
ta l F
iO 2/
PE E P
co m
bi na
tio ns
s u ch
a s
sh ow
n be
lo w
( no
t re
qu ir ed
) to
a ch
ie ve
g oa
l.
Lo w
e r
P E
E P
/ h
ig h
e r
F iO
2
F iO
2 0.
3 0.
4 0.
4 0.
5 0.
5 0.
6 0.
7 0.
7 P
E E
P
5 5
8 8
10
10
10
12
N
IH N
H LB
I A R
D S
C lin
ic al
N et
w or
k F iO
2 0.
7 0.
8 0.
9 0.
9 0.
9 1.
0 P
E E
P
14
14
14
16
18
18 -2
4 M
ec ha
ni ca
l V en
ti la
ti on
P ro
to co
l S um
m ar
y H
ig h
e r
P E
E P
/ lo
w e
r F
iO 2
F iO
2 0.
3 0.
3 0.
3 0.
3 0.
3 0.
4 0.
4 0.
5 P
E E
P
5 8
10
12
14
14
16
16
F iO
2 0.
5 0.
5- 0.
8 0.
8 0.
9 1.
0 1.
0 P
E E
P
18
20
22
22
22
24
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__
P LA
T E
A U
P R
E S
S U
R E
G O
A L : ≤ 3
0 c
m H
2 O
C he
ck P
pl at
( 0.
5 se
co nd
in sp
ir at
or y
pa us
e) , at
le as
t q
4h a
nd a
ft er
e ac
h ch
an ge
in P
E E P
or V
T .
If P
p la
t >
3 0
c m
H 2 O
: de
cr ea
se V
T b
y 1m
l/ kg
s te
ps (
m in
im um
= 4
m
l/ kg
).
If P
p la
t <
2 5
c m
H 2 O
a n
d V
T <
6 m
l/ k
g , in
cr ea
se V
T b
y 1
m l/ kg
u nt
il Pp
la t
> 2
5 cm
H 2O
o r
V T =
6 m
l/ kg
. If
P p
la t
< 3
0 a
n d
b re
a th
s ta
ck in
g o
r d
y s-
sy n
ch ro
n y o
cc u
rs :
m ay
in
cr ea
se V
T in
1 m
l/ kg
in cr
em en
ts t
o 7
or 8
m l/ kg
if P
pl at
r em
ai ns
< 3
0 cm
H
2O .
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
_ p
H G
O A
L: 7
.3 0
-7 .4
5
A ci
d o
si s
M a
n a
g e
m e
n t:
( p
H <
7 .3
0 )
If p
H 7
.1 5
-7 .3
0 :
In cr
ea se
R R u
nt il
pH >
7 .3
0 or
P aC
O 2
< 2
5
(M ax
im um
s et
R R =
3 5)
. .
If p
H <
7 .1
5 :
In cr
ea se
R R t
o 35
. If
p H
r em
ai ns
< 7
.1 5,
V T m
ay b
e in
cr ea
se d
in 1
m l/ kg
s te
ps u
nt il
pH >
7.
15 (
Pp la
t ta
rg et
o f
30 m
ay b
e ex
ce ed
ed ).
M
ay g
iv e
N aH
C O
3
A lk
a lo
si s
M a
n a
g e
m e
n t:
( p
H >
7 .4
5 )
D ec
re as
e ve
nt r
at e
if po
ss ib
le .
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__ __
__
I: E
R A
T IO
G O
A L:
R ec
om m
en d
th at
d ur
at io
n of
in sp
ir at
io n
be <
du
ra ti on
o f
ex pi
ra tio
n.
P A
R T
I I:
W E
A N
IN G
A
. C
o n
d u
ct a
S P
O N
T A
N E
O U
S B
R E
A T
H IN
G T
R IA
L d
a il
y w
h e
n :
1.
Fi O
2 ≤
0. 40
a nd
P E E P ≤
8 O
R F
iO 2
< 0
.5 0
an d
PE EP
< 5
. 2.
PE
E P
an d
Fi O
2 ≤
va lu
es o
f pr
ev io
us d
ay .
3.
Pa ti en
t ha
s ac
ce pt
ab le
s po
n ta
ne ou
s br
ea th
in g
ef fo
rt s.
( M
ay
de cr
ea se
v en
t ra
te b
y 50
% f
or 5
m in
u te
s to
d et
ec t
ef fo
rt .)
4.
Sy
st ol
ic B
P ≥
90 m
m H
g w
ith ou
t va
so pr
es so
r su
pp or
t.
5.
N o
ne ur
om us
cu la
r bl
oc ki
ng a
ge nt
s or
b lo
ck ad
e.
B .
S P
O N
T A
N E
O U
S B
R E
A T
H IN
G T
R IA
L (S
B T
):
If a
ll a
b o
v e
c ri
te ri
a a
re m
e t
a n
d s
u b
je ct
h a
s b
e e
n i
n t
h e
s tu
d y
fo r
a t
le a
st 1
2 h
o u
rs ,
in it
ia te
a t
ri a
l o
f U
P T
O 1
2 0
m in
u te
s o
f sp
o n
ta n
e o
u s
b re
a th
in g
w it
h F
iO 2
< 0
.5 a
n d
P E
E P
< 5
: 1.
P la
ce o
n T -p
ie ce
, tr
ac h
co lla
r, o
r C PA
P ≤
5 cm
H 2O
w ith
P S
< 5
2.
A ss
es s
fo r
to le
ra nc
e as
b el
ow f
or u
p to
t w
o h ou
rs .
a.
S pO
2 ≥
90 :
an d/
or P
aO 2 ≥
60 m
m H
g b.
S
po nt
an eo
u s
V T ≥
4 m
l/ kg
P B W
c.
R R ≤
3 5/
m in
d.
p
H ≥
7 .3
e.
N
o re
sp ir at
or y
di st
re ss
( di
st re
ss =
2 o
r m
or e)
¾
H R >
1 20
% o
f ba
se lin
e ¾
M ar
ke d
ac ce
ss or
y m
us cl
e u se
¾
A bd
om in
al p
ar ad
ox
¾ D
ia ph
or es
is
¾ M
ar ke
d dy
sp n ea
3.
I f
to le
ra te
d fo
r at
le as
t 30
m in
u te
s, c
on si
de r
ex tu
ba tio
n.
4.
If n
ot t
ol er
at ed
r es
um e
pr e-
w ea
ni ng
s et
tin g s.
D ef
in iti
on o
f U N
A S
S IS
T E
D B
R E
A T
H IN
G (D
if fe
re n
t fr
o m
t h
e sp
o n
ta n
eo u
s b
re at
h in
g
cr it
er ia
a s
P S
is n
o t
al lo
w ed
)
1.
E xt
ub at
ed w
ith fa
ce m
as k,
n as
al p
ro ng
o xy
ge n,
o r
ro om
a ir,
O R
2.
T
-t ub
e br
ea th
in g,
O R
3.
T
ra ch
eo st
om y
m as
k br
ea th
in g,
O R
4.
C
P A
P le
ss th
an o
r eq
ua l t
o 5
cm H
20 w
it h
o u
t p
re ss
u re
s u
p p
o rt
o r
IM V
a ss
is ta
n ce
.
