3. Basic Principles:
Establish Harm-Free Goals
1. SaO2 85-90% with certain exceptions
2. Follow pH not PaCO2
3. VT: ARDS versus other lung conditions
4. Paw: ARDS versus other lung conditions
5. Avoid drugs that may prolong weaning
(sedatives, neuromuscular blockers)
Better is the enemy of good…
29. A Auto - PEEP
10 cm H2O
External PEEP
0 cm H2O
B Auto - PEEP
10 cm H2O
External PEEP
8 cm H2O
C Net PEEP
12 cm H2O
External PEEP
12 cm H2O
Tobin MJ. Chest 1989; 96:449-451
Trigger Sensitivity and Auto-
PEEP
30. Minimizing the Impact of
Outflow Obstruction
1. Decrease rate (frequency)
2. Decrease VT
3. Increase inspiratory flow
rate
Volume vs Time ScalarVolume vs Time Scalar
InspirationInspiration
ExpirationExpiration
Time (sec)Time (sec)
VolumeVolume
(ml)(ml)
Inspiratory Tidal VolumeInspiratory Tidal Volume
TTII
40. Conclusions
1. Know the waveforms!
2. Synchronize the machine to the patient
3. “Seek” the cause of the problem by
analysis techniques shown here today
4. Use sedation only after you have
accomplished 1-3 (or in ARDS patients
with VT