Ventilatory management protocol
| Volume controlled | Time cycled, pressure limited | |
|---|---|---|
| Initial mode | PTV (Assist/Control) | PTV (Assist/Control) |
| Tidal volume | Adjust volume to deliver 5–8 mL/kg | Adjust PIP to deliver 5–8 mL/kg |
| Time limit | Use flow to adjust inspiratory time of 0.3–0.5 sec | Inspiratory time 0.3–0.5 sec, use expiratory trigger to achieve full synchronisation |
| Maintain target ABG | pH 7.27–7.40 | pH 7.27–7.40 |
| PCO2 4.5–6 KPA | PCO2 4.5–6 KPA | |
| PO28–11KPA | PO2 8–11 KPA | |
| Weaning | Wean by reducing rate but continue to deliver tidal volume of 5–8 mls/kg. When rate ⩽40 bpm, switch to SIMV with PSV (minimum 10–12 cm H2O) | Wean by reducing PIP as tolerated but continue in PTV with control rate of 20–40 bpm and tidal volume delivery at 5–8 mls/kg. |
| “Success” criteria outcome | A-aDO2 <13 kpa1-150 >12 h | A-aDO2 <13 kpa >12 h |
| or | or | |
| MAP<8.0 cm HsO >12 h | MAP <8.0 cm H2O >12 h | |
| or | or | |
| Extubation (>12 hrs) before predetermined end points | Extubation (>12 hrs) before predetermined end points |
↵1-150 100 torr (1 KPA=7.5 torr). PTV=patient triggered ventilation; SIMV=synchronised intermittent mandatory ventilation; PSV=pressure support ventilation; ABG=arterial blood gas; MAP=mean artery pressure; PIP=pulmonary inspiratory pressure.