The NIH Adult Respiratory Distress Syndrome (ARDS) Network developed a ventilator strategy using a lower tidal volume. Adjustments may be necessary if acidosis or alkalosis occur.
ventilator mode: volume assist/control
pH
Recommended Management
< 7.15
consider increasing tidal volume (inspiratory plateau pressure may be > 30 cm H2O); increase respiratory rate as for 7.15 to 7.29 (next)
7.15 to 7.29
increase respiratory rate; if pH does not correct and the maximum respiratory rate has been reached then consider infusion of bicarbonate
7.30 to 7.45
no adjustments needed
> 7.45
if the patient is not triggering the ventilator, decrease the respiratory rate
maximum respiratory rate: 35 breaths per minute
minimum respiratory rate: 6 breaths per minute
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