Protective lung ventilation



General

Protective lung ventilation aims for low tidal volume ventilation. A large study has shown a decrease in mortality, when patients with acute lung injury/ARDS were ventilated with low tidal volumes. Today, the protective lung ventilation algorithm by the ARDS network provides a reasonable default approach for mechanically ventilated patients, especially those at risk for developing ARDS

Ventilation setup and adjustment

Oxygenation Goal

FiO₂ low PEEP high PEEP
0.3 5 5 – 14
0.4 5 – 8 14 – 16
0.5 8 – 10 16 – 20
0.6 10 20
0.7 10 – 14 20
0.8 14 20 – 22
0.9 14 – 18 22
1.0 18 – 24 22 – 24

Plateau pressure

pH

Permissive hypercapnia

Elevated PaCO₂ can be the result of low volumes and should be tolerated, as long as the pH is manageable. The articles I’ve come across so far suggest an pH > 7.1 or > 7.2 as tolerable.

Pocket card

The gist of this page is available as pocket card. You can download it via the link below.

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