ACS Stroke Sepsis

Early Goal-Directed Therapy (Sepsis) Program

Mechanical Ventilation of ALI/ARDS

1. Target tidal volume of 6ml/kg (predicted weight) in pts with ALI/ARDS (1B)
2. Consider upper limit plateau pressure of <30cm H20 and factor chest wall compliance into this decision (1C)
3. Allow supranormal PaCO2 to minimize plateau pressures and tidal volumes (if needed) (1C).
4. Use PEEP to avoid lung collapse at the end of expiration (1C).
5. Consider laying pts in ARDS prone if at dangerous levels of FiO2, plateau pressures and positioning changes are not injurious (2C):
6. Mechanically ventilated pts should have head of bed elevated to 45 degrees (1B) unless contraindicated, then put between 30 and 45 degrees (2C)
7. Consider non-invasive ventilation in pts with mild to moderate hypoxemia that are hemodynamically stable, comfortable, easily arousable, able to protect airway and rapid recovery is expected (2B).
8. Pulmonary artery catheters should not be used for routine monitoring in pts with ALI/ARDS (1A).
9. Use a conservative fluid strategy in pts with ALI and no evidence of tissue hypoperfusion (1C).

Select Abbreviations Antibiotics APACHE II Bicarbonate Therapy Diagnosis DVT Prophylaxis Fluid Therapy Glucose Control Inotropic Support Levels Of Evidence Mechanical Ventilation of ALI/ARDS References Renal Replacement Sedation and Analgesia Sepsis Criteria Sepsis Definitions Source ID and Control Steroids Stress Ulcer Prophylaxis Vasopressors Xigris Indications

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