Manejo de la ventilación mecánica en pacientes con SDRA o ALI

Initial ventilator settings

Calcular el peso ideal
Mujer Varón
    Altura cm
Peso ideal =
 Vt 8 ml/kg =
 Vt 6 m/kg =
Set mode to volume assist-control
Set initial tidal volume to 8 ml/kg PBW
Reduce tidal volume to 7 and then to 6 ml/kg over 1-3 hours
Set initial ventilator rate 35 breaths/min to match baseline minute ventilation
Subsequent tidal volume adjustment
Plateau pressure (Pplat) goal <30 cmH2O 
Check inspiratory plateau pressure with 0.5 second inspiratory pause at least every four hours and after each change in PEEP or tidal volume.
If Pplat >30 cmH2O, decrease tidal volume in 1 ml/kg PBW steps to 5 or if necessary to 4 mL/kg PBW.
If Pplat <25 cmH2O and tidal volume <6 ml/kg, increase tidal volume by 1 mL/kg PBW until Pplat >25 cmH2O or tidal volume = 6 ml/kg.
If breath stacking (autoPEEP) or severe dyspnea occurs, tidal volume may be increased to 7 or 8 mL/kg PBW if Pplat remains <30 cmH2O.
Arterial oxygenation and PEEP
Oxygenation goal PaO2 55-80 mmHg or SpO2 88-95 percent
Use these FiO2/PEEP combinations to achieve oxygenation goal:
FiO2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
PEEP 5 5-8 8-10 10 10-14 14 14-18 18-22
PEEP should be applied starting with the minimum value for a given FiO2.
Adapted from: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000; 342:1301.