Page 16 - 2026 SMOG

VENTILATOR MANAGEMENT
Lower PEEP/Higher FiO Titration Table – ARDSNet ARMA Trial
2
PEEP 5 5 8 8 10 10 10 12 14 14 14 16 18 18
FiO 2 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
Move across table to keep SaO 92–96%
2
Patients falling in the shaded area are not necessarily too sick for flight; consider the risks and
benefits as described in the CPG
*NOTE: Hypotensive patients (MAP <70 or SBP <90) may respond negatively to increased PEEP
due to decreased venous return. Monitor for increasing hypotension and tachycardia
(Alternate) Higher PEEP/Lower FiO Titration Table – ARDSNet ARMA Trial
2
PEEP 5 8 10 12 14 14 16 16 18 20 22 22 22 24
FiO 0.3 0.3 0.3 0.3 0.3 0.4 0.4 0.5 0.5 0.5 –0.8 0.8 0.9 1.0 1.0
2
Oxygenation Goals:
• Normal: PaO 80–100mmHg or SpO 90–96% (SAVEO )
2
2
2
• ARDS: PaO 55–80mmHg or SpO 88–95%
2
2
Plateau Pressure Goal: ≤30cmH O
2
• Check Pplat (0.5 second inspiratory pause) at least every 4 hours and after each change in
PEEP or Vt
Peak Inspiratory Pressure Goal:
• ≤35mmHg, ideally below 30mmHg
Alarm Settings
• High Pressure Alarm: 10cmH O above peak airway pressure
2
˚ Alternate: 50% above baseline PIP (1.5× current PIP)
• Low Pressure Alarm: 5cmH O below peak airway pressure
2
˚ Alternate: 50% below baseline PIP (0.5× current PIP)
**Determine pressures by placing the patient on a ventilator for ~1–2min and determining
intrinsic PIP (Labeled as PEAK on 754 ventilator [top right]; labeled as Ppeak on Hamilton T1
[top left])**
Monitor the waveform on the machine and the patient to ensure no breath stacking occurs. If this
occurs, a high-pressure alarm may sound. However, if breath stacking is suspected even in the
absence of an alarm, disconnect tubing and allow exhalation. Increase I:E.
Troubleshooting
Airway Compromise or Lost Airway In-Flight
• If, at any time, the patient begins to desaturate or develop respiratory problems, immediately
disconnect the ventilator and ventilate the patient with a BVM (with PEEP valve if available)
and 100% O while correcting issues utilizing the D.O.P.E. algorithm:
2
(continues)

8 • GENERAL