1. ARDS net

2. ARDSnet Ventilatory Strategy First Stage Calculate predicted body weight - 0.91x(height in cm-152.4)+50/45.5 Set Mode - VC/AC Set initial TV to 8 ml/Kg PBW Add PEEP of 5-7 cm H2O Reduce TV by 1 ml/kg every 2 hours until TV = 6 ml/Kg PBW

3. ARDSnet Ventilatory Strategy Second Stage When TV 6 ml/kg measure inspiratory plateau pressure with 0.5s pause Target Pplat < 30 cm H2O Measure Pplat 4hourly & after every change in PEEP or TV If Pplat > 30 reduce TV 1 ml/kg until Pplat < 30 or TV 4ml/kg Pplat < 25 & TV < 6ml/Kg increase TV

4. ARDSnet Ventilatory Strategy Third Stage Monitor ABG for respiratory acidosis Target pH = 7.3 – 7.45 If pH 7.15 – 7.30 increase RR until pH > 7.30 or RR > 35/min If pH < 7.15 increase RR to 35 If pH still 7.15 Do not increase RR if PCO2 < 25 If pH < 7.30 & RR 35/min consider Bicarb inf pH > 7.45 & patient not triggering decrease RR (> 6/min)

5. ARDSnet Ventilatory Strategy Oxygenation goal: PaO 2 55 - 80 mmHg/ SpO 2 88 - 95% FiO 2 <70% Allowable combination of FiO 2 and PEEP: FiO 2 0.3 0.4 0.4 0.5 0.5 0.6 0.7 0.7 0.7 0.8 PEEP 5 5 8 8 10 10 10 12 14 14 FiO 2 0.9 0.9 0.9 1.0 1.0 1.0 1.0 PEEP 14 16 18 18 20 22 24