Initial Ventilator Management in ARDS

Generally, the following approach is recommended for ventilator management in ARDS:

• Assist-control mode is used initially with a tidal volume 6 mL/kg ideal body weight, respiratory rate 25/minute, flow rate 60 L/minute, FIO2 1.0, and PEEP 15 cm H2O.

• Once oxygen saturation is > 90%, FIO2 is decreased.

• Then, PEEP is decreased in 2.5-cm H2O increments as tolerated to find the least PEEP associated with an arterial oxygen saturation of 90% on an FIO2 of ≤ 0.6.

• The respiratory rate is increased up to 35/minute to achieve a pH of > 7.15, or until the expiratory flow tracing shows end-expiratory flow.

Ideal body weight (IBW) rather than actual body weight is used to determine the appropriate tidal volume for patients with lung disease who are receiving mechanical ventilation.