Treat underlying cause
Cover for sepsis
Pneumonia in addition to other identified source
Tamiflu 75mg BID oral or NGT if influenza season 
Cover for sepsis
Pneumonia in addition to other identified source
Tamiflu 75mg BID oral or NGT if influenza season 
Pneumonia in addition to other identified source
Consider in early, established, severe<unk>  in ICU setting
NOT for prevention of<unk>  (will increase risk for<unk>  and worsening sepsis if not in<unk>  already)
In theory, may reduce fibro-proliferative inflammatory changes during exudative phase (< 1 wk)
No benefit to starting in late<unk>  (> 2 wks)
Meduri protocol (21 vs. 43% mortality)
1mg/kg loading dose methylprednisolone
Followed by infusion of 1mg/kg/day from day 1-14
Then 0.5mg/kg/day from day 15-21
Then 0.25mg/kg/day from day 22-25
Finally 0.125mg/kg/day from day 26-28
NOT for prevention of<unk>  (will increase risk for<unk>  and worsening sepsis if not in<unk>  already)
In theory, may reduce fibro-proliferative inflammatory changes during exudative phase (< 1 wk)
No benefit to starting in late<unk>  (> 2 wks)
1mg/kg loading dose methylprednisolone
Followed by infusion of 1mg/kg/day from day 1-14
Then 0.5mg/kg/day from day 15-21
Then 0.25mg/kg/day from day 22-25
Finally 0.125mg/kg/day from day 26-28
Lung Protective Ventilator Settings should be the default for all intubated patients, unless contraindicated. It has demonstrated mortality benefit for<unk> -like pulmonary conditions; limits barotrauma and decreases complications of high FiO2
Volume-assist control
Start 6-8cc/kg predicted body weight
Predicted/"ideal" body weight is used because a person's lung parenchyma does not increase in size as the person gains more weight.
Titrate down if plateau pressure >30 mmHg
Predicted/"ideal" body weight is used because a person's lung parenchyma does not increase in size as the person gains more weight.
More comfortable if higher rather than lower
Start at 60-80 LPM
Average patient on ventilator requires 120mL/kg/min for eucapnia
Start 16-18 breaths/min
Maintain pH = 7.30-7.45
Move in tandem to achieve:
SpO2 BETWEEN 88-95%
PaO2 BETWEEN 55-80mmHg
Permissive hypercapnia
Maintain plateau pressures < 30 
Ensure adequate sedation
Better synchrony with vent
Decreased oxygen consumption
Less delirium
Increased patient comfort
Prone ventilation 
Increases survival for severe<unk> 
Consider for refractory hypoxemia
Many consider this a type of recruitment maneuver
Consider Airway pressure release ventilation (APRV)
Pressure control ventilation (PCV) if acidosis with APRV
Attempt to maintain same rate
Maintain same Pmean
PRVC or Volume control ventilation with paralysis to prevent barotrauma in breath stacking and vent dyssynchrony
Cisatricurium loading dose 0.15 mg/kg, followed by 1-3 mcg/kg/min
Titrated to less than 2 twitches in train of four
Cisatricurium preferred to pancuronium in renal impairment
Cannot use paralysis with APRV
Recruitment maneuver
Varying methods and protocols
Controversial in risks and benefits
Better synchrony with vent
Decreased oxygen consumption
Less delirium
Increased patient comfort
Increases survival for severe<unk> 
Consider for refractory hypoxemia
Many consider this a type of recruitment maneuver
Attempt to maintain same rate
Maintain same Pmean
Cisatricurium loading dose 0.15 mg/kg, followed by 1-3 mcg/kg/min
Titrated to less than 2 twitches in train of four
Cisatricurium preferred to pancuronium in renal impairment
Cannot use paralysis with APRV
Varying methods and protocols
Controversial in risks and benefits
Evidence of pulmonary hypertension
Inhaled nitric oxide (iNO)
Epoprostenol (prostacyclin)
ECMO
Oscillation ventilation, High frequency oscillation ventilation (HFOV)
Inhaled nitric oxide (iNO)
Epoprostenol (prostacyclin)
Acute respiratory distress syndrome
Pneumonia
Respiratory distress syndrome
PE
Severe acute respiratory syndrome
Diffuse alveolar hemorrhage
Ventilator associated pneumonia
DIC