Aerosol-generating procedure: see this link for PPE recommendations and related precautions
Use checklist if available (see example: File:Harbor<unk>  Airway Management v3-16-20.pdf)
Use BVM with viral filter or avoid BVM altogether, if possible
Use RSI to prevent coughing gagging; consider higher dosing of paralytics.
Use video laryngoscopy to keep provider face further away from patient (afterwards, clean with grey wipes, observe 3 min wet time)
Lung Protective Ventilator Settings should be the default for all intubated patients, unless contraindicated. It has demonstrated mortality benefit for ARDS-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
See also deterioration after intubation
Hypoxemic patients can be divided into two general phenotypes
Characterized by Low elastance (i.e., high compliance), Low ventilation to perfusion ratio, Low lung weight and Low recruitability
Often referred to as the “happy hypoxemic”
Normal lung volumes and low lung recruitability.
Hypoxemia may be due to loss of regulation of perfusion and loss of hypoxic vasoconstriction.
These patients can be damaged iatrogenically if you respond to their pulse ox with standard vent modes
Do poorly with low tidal volume (TV) and high PEEPs
Best managed with high FiO2 which allows you to limit the PEEP
Recommended initial vent settings:
8 ml/kg TV, 100% FiO2
Increase the PEEP only if the patient is desaturating on a high FiO2.
Can turn into<unk>  H patients on the vent.
8 ml/kg TV, 100% FiO2
Increase the PEEP only if the patient is desaturating on a high FiO2.
Can turn into<unk>  H patients on the vent.
Characterized by High elastance, High right-to-left shunt, High lung weight and High recruitability.
Increased permeability of the lung leads to edema, atelectasis, decreased gas volume, and decreased TV for a given inspiratory pressure.
High degree of lung recruitability.
20 – 30% of patients fit ARDS criteria:
Hypoxemia
Bilateral infiltrates
Decreased the respiratory system compliance
Increased lung weight and potential for recruitment
The ARDS ladder applies only to this subset of<unk>  patients.
Hypoxemia
Bilateral infiltrates
Decreased the respiratory system compliance
Increased lung weight and potential for recruitment
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