QUY TRÌNH THỞ MÁY BỆNH NHÂN ARDS

                     Acute Respiratory Distress Syndrome (ARDS) Protocol

Ventilator Management Arm

1.  Calculate IBW ________.            Record 4 ml/kg:_________.    6 ml/kg:________.   8 ml/kg:_________.                   

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) -152.5]

2.  Mode: PRVC or AC

3.  Tidal Volume (Vt): Set Vt = 6 ml/kg.

4.  Rate: Titrate rate (and thereby minute ventilation) to achieve a goal pH of between 7.30 and

     7.45 up to a maximum rate of 35.

a. If RR=35 and pCO2 <25 OR RR=35 and pH <7.15 consider NaHCO3 infusion

b. If RR=35 and pH <7.15 and NaHCO3 has been considered or infused, then Vt may be increased in 1 ml/kg increments until pH ≥7.15 (Pplat target may be exceeded in this circumstance.)

5.  Measure plateau pressures, SpO2, RR, and ABG q 4 hours until at goal parameters, and after

     every change in Vt, RR and/or PEEP.  Record SpO2, RR, Vt, Pplat and vent settings every 4

     hours thereafter. 

6.  Goal Pplat < 30 cm H2O:  If plateau ≥ 30 cm H2O then reduce tidal volume further towards a

     minimum of 4 ml/kg IBW while pH remains ≥ 7.15.  End titration when plateau is < 30 OR pH < 7.15.

a. If Pplat < 25 cm H2O AND Vt < 6 ml/kg, may titrate Vt back towards 6 ml/kg as long as Pplat remains < 30 cm H2O

b. If Pplat <30 AND breath stacking occurs may increase Vt in 1 ml/kg increments up to a maximum of 8ml/kg.

7.  Set inspiratory flow rate above patient demand (usually ≥ 80L/min.)  I:E ratio goal of 1:1.0-1.3. 

8.  Titrate FiO2 and PEEP every 15 minutes to goal PaO2 between 55 and 80 mmHg OR SpO2

      between 88 and 95% with the following suggested relationship.

FiO2	0.3	0.4	0.4	0.5	0.5	0.6	0.7	0.7	0.7	0.8	0.9	0.9	0.9	1.0
PEEP	5	5	8	8	10	10	10	12	14	14	14	16	18	20-24

a. If adequate oxygenation cannot be achieved, evaluate for prone positioning.

b. Call physician for PEEP associated hemodynamic compromise

c. Note that PEEP represents set PEEP on the ventilator NOT auto-PEEP or total PEEP.

9.   Call MD for arterial line if ≥ 4 ABG in 24 hours will be necessary

10. CXR daily q AM

11. ABG daily q AM

MD Signature: ____________________________________ Date and Time: ____________________________

                                                                                                                                                                                                   

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