Male
Height
4’ 6"
4’ 7"
4’ 8"
4’ 9"
4’ 10"
4’ 11"
5’ 0"
5’ 1"
5’ 2"
5’ 3"
5’ 4"
5’ 5"
5’ 6"
5’ 7"
5’ 8"
5’ 9"
5’ 10"
5’ 11"
6’ 0"
6’ 1"
6’ 2"
6’ 3"
6’ 4"
8 ml
6 ml
Inches kg PBW kg PBW
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
290
310
330
350
370
380
400
420
440
460
480
490
510
530
550
570
590
600
620
640
660
680
700
220
230
250
260
270
290
300
320
330
340
360
370
390
400
410
430
440
450
470
480
500
510
520
Female
4 ml
kg PBW
8 ml
kg PBW
6 ml
kg PBW
4 ml
kg PBW
150
160
170
170
180
190
200
210
220
230
240
250
260
270
280
290
290
300
310
320
330
340
350
260
270
290
310
330
350
370
380
400
420
440
460
480
500
510
530
550
570
590
610
620
640
660
190
210
220
230
250
260
280
290
300
320
330
340
360
370
390
400
410
430
440
450
470
480
500
130
140
150
160
170
180
180
190
200
210
220
230
240
250
260
270
280
290
290
300
310
320
330
King County Lung Injury Project
Height and Weight Tidal Volume Conversion Chart
Tips for using lung protective ventilation in acute lung injury
• Set tidal volume according to predicted body weight (PBW) based on height and gender.
Use tables or formulas – do not use measured weight. Predicted Body Weight Male=50+2.3(height (in.)-60)
Predicted Body Weight Female=45.5+2.3(height (in.)-60)
• Use airway pressure at end-inspiration (plateau or static pressure) to adjust tidal volume.
Initiate lung protective ventilation at 8 ml/kg PBW and reduce slowly to 6 ml/kg PBW target.
Peak airway pressure is not used to adjust flow rate or tidal volume.
Reduce tidal volume further if plateau pressure is > 30 cm H2O until 4 ml/kg PBW.
May increase tidal volume if plateau pressure is < 30 cm H2O until 6 ml/kg PBW.
• Static pressures may go above 30 cm H2O if
Tidal volume is down to the minimum 4 ml/kg PBW.
Tidal volumes greater than 6 ml/kg PBW are needed to manage severe acidosis.
Oxygenation goals cannot be met with other methods.
• If you choose to use pressure control ventilation to deliver lung protective ventilation.
Pressure oriented modes of ventilation have not been shown to improve outcome compared to volume modes
of ventilation in acute lung injury.
Keep pressure control + total PEEP < 30 and the delivered tidal volume < 6 ml/kg PBW.
If the tidal volume increases during pressure control ventilation, then the pressure setting must be decreased
until the delivered tidal volume < 6 ml/kg PBW.
• Things to expect when you use lung protective ventilation and what to do about them
Tolerate respiratory rates up to 40 if not sustained.
Important to distinguish tachypnea due to small tidal volumes from discomfort and
ventilator dysynchrony.
Tachypnea
Increased sedation may be necessary during lung protective ventilation
Discomfort
Tachypnea alone is not a reliable sign of discomfort during lung protective ventilation
–use other signs (grimacing, nasal flaring, oxygenation) in addition to respiratory rate
to assess comfort and need for sedation.
Ventilator
dysynchrony
“Stacking”
Worsening
ventilation
Consider autoPEEP, inadequate inspiratory flow rate, trigger sensitivity, circuit water,
suctioning, pneumothorax, bronchospasm.
After excluding these problems, either tolerate occasional breath stacking or increase
sedation.
Paralysis is rarely, if ever, needed to treat ventilator dysynchrony.
Although rarely necessary, if frequent (> 6/minute) stacking does not resolve with the
above, try small (50ml) increments in tidal volume (may exceed 6 ml/kg PBW as long
as Pplat < 30). When stable, reduce tidal volume back to 6 ml/kg PBW.
Elevated PaCO2 (hypercapnea) is common during lung protective ventilation.
Tolerate pH to 7.15 as long as no cardiovascular complications are present
Initiation of lung protective ventilation can be challenging, and many clinicians give
up on the therapy because oxygenation worsens. Reductions in tidal volume should
proceed slowly (e.g. over 2 hrs) – particularly with initial tidal volume reduction and
when oxygenation and pH are marginal. (See order sheet.)
Worsening
Increased PEEP may be needed when tidal volumes are reduced.
oxygenation
Serial reductions in tidal volume and increases in PEEP may be necessary until the
patient is stabilized with adequate oxygenation and acceptable tidal volume.
PaO2 > 55 or SaO2 > 88% is acceptable and provides adequate oxygenation
A common and acceptable arterial blood gas during lung protective ventilation is pH
7.27, PaCO2 62, PaO2 58
• Weaning can begin when patients are on < 40% FiO2 and < 8 cm H2O PEEP with PaO2 > 60. If
oxygenation worsens, then patients need to return to lung protective ventilation.
© 2002 Ki
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