All excited for intubation but forget to optimize the ventilatory settings?
Important for those that are not rapidly taken away to the ICU.
Ventilation
Tidal Volumes: low tidal volumes 6 ml/kg (ideal body weight) even without acute lung injury is even beneficial. Study by Determann et al. 2010 Critical Care. Looked at 150 patients, randomized trial of 10 vs 6 ml/kg. Development of Acute lung injury in 13.5 in the 10 ml/kg group and 2.6 in the 6 ml/kg group. Stopped early because of difference.
Respiratory Rate: Minute ventilation is RRxTV. You want a MV of 5-6L/min in a normal patient, but if need to increase for metabolic derrangement may need much higher. Permissive hypercapnea is okay in those with ARDS. Caution in those with brain injury and severe metabolic acidosis. Don’t go higher than RR of 35. Keep ph>7.15, as done in ARDSnet. Continue reading