Definition of ARDS (Acute Respiratory Distress Syndrome):
- Acute onset (within 1 week)
- PaO2 / FiO2 < 300 (corrected for altitude)
- Bilateral infiltrates consistent with pulmonary edema
- No clinical evidence of left atrial hypertension (no evidence of heart failure or volume overload)
P:F Ratio
Predicted Body Weight
Oxygenation goal: SaO2 88-95% or PaO2 55-80 mmHg
- ↑ FiO2
- ↑ PEEP
Plateau pressure goal: ≤ 30 cm H2O
- Pplat > 30 → decrease VT by 1mL/kg steps (min = 4 mL/kg)
- Pplat < 25 and VT < 6 mL/kg → increase VT by 1 mL/kg steps
- Pplat < 30 and breath stacking or dys-synchrony occurs → increase VT by 1mL/kg steps
pH goal: 7.3 - 7.45
- pH 7.15 - 7.3 → ↑ RR until pH = 7.3 or PaCO2 < 25
- pH < 7.15 → ↑ RR to 35
- pH > 7.45 → ↓ RR
NHLBI ARDS Network Text