Lung Protective Tabulations now availabe as a multi-touch books on iTunes (see link below).
Tuesday, July 10, 2018
Wednesday, July 4, 2018
Limiting Driving Pressure
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Pressure Control Setting For Targeting Tidal Volume per Ideal Body Weight [1].
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Driving pressure has been shown to be a better determinant of ARDS outcomes than tidal
volume, plateau pressure, or PEEP. "A driving pressure > 14 cmH2O was associated with increased
60 day mortality" [1].
Titrating tidal volume to maintain driving pressures < or = to 14 cmH2O with minimal costs in regards to CO2 clearance is a practical strategy to reduce the risk of volutrauma [1].
Titrating tidal volume to maintain driving pressures < or = to 14 cmH2O with minimal costs in regards to CO2 clearance is a practical strategy to reduce the risk of volutrauma [1].
The practitioner can easily meet this target by utilizing Pressure-control ventilation and
never setting the pressure > 14 cmH2O.
The above set of tables "Pressure Control Setting for Targeting Vt/Kg IDBW" displays the relationships between tidal volume, compliance, and pressure control setting (driving pressure). These tables can be used a few ways:
1. To determine the PC setting to target a specific VT for a measured compliance.
2. If using Volume-control (fully decelerating flow pattern only) or a Adaptive Pressure-control
(e.g. PRVC, Auto-Flow, APV, VC+) predicts what the driving pressure will be for your set VT based on measured compliance.
3. Titrating tidal volumes to maintain driving pressures < or = to 14 cmH2O.
Inputs- height (inches or centimeters), VT target (4, 5, 6, ml kg), compliance, gender.
Outputs- IDBW (KG), VT/Kg (ml), Driving pressure.
The above set of tables "Pressure Control Setting for Targeting Vt/Kg IDBW" displays the relationships between tidal volume, compliance, and pressure control setting (driving pressure). These tables can be used a few ways:
1. To determine the PC setting to target a specific VT for a measured compliance.
2. If using Volume-control (fully decelerating flow pattern only) or a Adaptive Pressure-control
(e.g. PRVC, Auto-Flow, APV, VC+) predicts what the driving pressure will be for your set VT based on measured compliance.
3. Titrating tidal volumes to maintain driving pressures < or = to 14 cmH2O.
Inputs- height (inches or centimeters), VT target (4, 5, 6, ml kg), compliance, gender.
Outputs- IDBW (KG), VT/Kg (ml), Driving pressure.
REFERENCE
Richey KS. Lung Protective Tabulations, 2018
Tuesday, July 3, 2018
MINIMIZING THE RISK OF VOLUTRAUMA
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| Ideal Body Weight & Tidal Volume Tables[1]. |
The aim to minimize the risk of volutrauma is associated with the objective to optimize the pressure/volume curve. To accomplish this the clinician targets a minimal tidal volume and optimal PEEP which maximizes compliance and avoids volutrauma as well as atelectrauma.
One strategy to reduce the risk volutrauma is to target a tidal volume of 4 to 6 ml/kg/Ideal body weight per ARDS net guidelines
.
The pictured group of tables "IDEAL BODY WEIGHT & TIDAL VOLUME Per Ml for both genders" [1] provide tidal volume targets of 4,5,& 6 ml/kg/IDBW.
Inputs- Height (inches or centimeters) & Gender.Outputs- Ideal body weight (kg), target tidal volume (4, 5, 6 ml/kg).
Reference
1. Richey KS. Lung Protective Tabulations 2018
One strategy to reduce the risk volutrauma is to target a tidal volume of 4 to 6 ml/kg/Ideal body weight per ARDS net guidelines
.
The pictured group of tables "IDEAL BODY WEIGHT & TIDAL VOLUME Per Ml for both genders" [1] provide tidal volume targets of 4,5,& 6 ml/kg/IDBW.
Inputs- Height (inches or centimeters) & Gender.Outputs- Ideal body weight (kg), target tidal volume (4, 5, 6 ml/kg).
Reference
1. Richey KS. Lung Protective Tabulations 2018