Page 197 - 2023 SMOG Digital

o Set the FiO 2 to 30% and start titrating FiO 2 and PEEP collectively based on the chart to achieve oxygenation goals. Go up
q5-10min; quicker if low SpO 2 sats develop.

* Hypotensive patients (MAP <70 or SBP <90) may respond negatively to increased PEEP causing decreased
venous return. Monitor for increased hypotension and tachycardia.
• Alternate Higher PEEP settings

• Oxygenation Goal: PaO 2 55-80 mmHg or SpO 2 88-95%
• Plateau Pressure Goal: ≤30cm H 2 O
o Check Pplat (0.5 second inspiratory pause), at least q4hr and after each change in PEEP or VT.
o If Pplat >30cm H 2 O: decrease VT by 1ml/kg steps (minimum = 4ml/kg).

o If Pplat <25cm H 2 O and VT<6ml/kg, increase VT by 1 ml/kg until Pplat >5cm H 2 O or VT = 6ml/kg.

o If Pplat <30 and breath stacking or dys-synchrony occurs: may increase VT in 1ml/kg increments to 7 or 8ml/kg
if Pplat remains <30cm H 2 O.
• Alarm Settings:
o High Pressure Alarm: 10cm H 2 0 above peak airway pressure
o Low Pressure Alarm: 5cm H 2 O below peak airway pressure
or
o High Pressure Alarm 50% above the baseline PIP (1.5 x current PIP)
o Low Pressure Alarm 50% below the baseline PIP (0.5 x current PIP)
** Pressures will be determined by placing patient on vent for ~1-2 minutes and determining intrinsic peak inspiratory
pressure. (Labeled as PEAK on 754 Ventilator (top right); Labeled as Ppeak on Hamilton T1 ventilator (top left).
• Monitor waveform on machine and patient to ensure not “breathe stacking” – if this occurs, a high-pressure alarm may sound.
However, if breath stacking suspected even in absence of alarm – disconnect tubing and allow exhalation. Increase I:E.

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