take the ventilator out of the equation-bag the patient to...

Otherpatients(i.e.modificationsfromLUNGPROTECTIVESTRATEGY)

§ HEADINJURY:toomuchPEEPcanêBPandthusêcerebralperfusionpressure.PEEP=5(default)isOK. 30oheadup.AimforCO235-40mmHg

§ METABOLICACIDOSIS:RR>patientachieved,ETCO2<patientachieved.Lightensedationtoallowpatienttoaddadditionalbreathsasrequired-addpressuresupport(Δsupp=10,Trigger=2)tothesebreathsaspatienttired.

§ HYPERTENSIVEAPO:startPEEPat10cmH20andrapidlytitrateupwhilerapidlytitratingIVGTNforSBP<140.§ OBESE:startPEEPat10cmH20andtitrateasperPEEP/FiO2scale.ReverseTrendelenburg/ramped§ CARDIOGENICSHOCK:avoidhigh-levelPEEPascanêBP.§ PREGNANCY:leftlateralposition.TV:8ml/kgidealbodyweight,RR20-22bpmaimforlow/normalpCO2&normalpH.

Ifpatientiscrashing….§ Taketheventilatoroutoftheequation-bagthepatienttofeelhowtheyaretoventilate§ Checkthetube-displaced/dislodged/obstructed§ Checkthepatient-pneumothorax-bedsideUS/CXRandneedle/fingerthoracostomy§ Checktheventilator

5’0”153cm

5’2”156cm

5’4”163cm

5’6”168cm

5’8”173cm

5’10”178cm

6’183cm

6’2”188cm

6’4”193cm

VTwomen(6ml/kgIBW) 276 295 330 360 385 415 440 470 490VTmen(6ml/kgIBW) 305 320 360 385 415 440 470 490 520

GUIDEFORINITIALSETTINGSFORPRESSURECONTROLLEDVENTILATIONFORDRAEGEROXYLOG3000PLUS

Assumespatientisapnoeicfromsedation&nursedat30otominimiseaspiration.RecommendedforallUNCUFFEDtubes

LUNGPROTECTIVESTRATEGY(allotherpatients)

OBSTRUCTIVESTRATEGY(bronchiolitis/asthma)

Mode PC-SIMV+ PC-SIMV+

VT can’tbesetinPCmode-VTdeterminedbyPisnp can’tbesetinPCmode-VTdeterminedbyPisnp

RR seechart-thentitratetonormalpCO2/pH

(1/2normalRR)-seechartthenEXPIRATORYFLOWTIMECURVES.êRRifnotfullyexpiring

-permissivehypercapnoea(pH>7.1)

Pmax(alarm) highenoughtoallowdesiredVT(ifalarms,seebelow) highenoughtoallowdesiredVT(ifalarms,seebelow)

FiO2

titrateusingFiO2/PEEPscaleèSpO2of88-95% minimalFiO2forSpO288-95%

PEEP 5(default)

Pinsp startat20andtitratetoVTof6ml/kgIdealBodyWeight-seechart

startat20andtitratetoVTof6ml/kgIdealBodyWeight-seechart

Tinsp I:E=1:2(default) titrateTinspsothatI:E=>1:4

Slope (default) (i.e.fastinspiratoryflowrate)

Other

§ ifhighPEEPresultsinêBP,givefluids&inotropeskeepingSBPasperchart

§ ifPmaxalarms,checkforpatientagitation/tubeobstruction.ifnotthecause,performINSPIRATORYHOLDMANOEUVRE-

ifPplat>30êTVby1ml/kgsteps(min4ml/kg)

§ sedate++++,avoidongoingparalysis§ ifêêBP+difficulttoventilate,disconnecttube&allowto

expirestackedbreaths§ ifPmaxalarms,checkforpatientagitation/tubeobstruction.

ifnotthecause,performINSPIRATORYHOLDMANOEUVRE-ifPplat>30êTVby1ml/kgsteps(min4ml/kg)

FurthermodificationsdependsonhourlyABGsandhaemodynamics