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Appendix 1 Table 1 National Institutes of Health Acute Respiratory Distress Syndrome Network lower tidal volume ventilation for acute lung injury/acute respiratory distress syndrome protocol summary

From: Reducing mortality in sepsis: new directions

Variable

Protocol

Ventilator mode

Volume assist control

Tidal volume

≤ 6 ml/kg predicted body weight (subsequent adjustments were made to maintain plateau pressure ≤ 30 cmH2O)

Plateau pressure

≤ 30 cmH2O

Ventilation set rate/pH goal

6–35 breaths/min, adjusted to achieve arterial pH 7.3–7.45 if possible

Inspiratory flow, I:E

Adjust flow to achieve I:E of 1:1–1:3

Oxygenation goal

PaO2 of 55 ≤ 80 mmHg, or SpO2 of 88% ≤ 95%

FiO2/PEEP (mmHg) combinations

0.3/5, 0.4/5, 0.4/8, 0.5/8, 0.5/10, 0.6/10, 0.7/10, 0.7/12, 0.7/14, 0.8/14, 0.9/14, 0.9/16, 0.9/18, 1.0/18, 1.0/22, 1.0/24

Weaning

Attempts to wean by pressure support required when FiO2/PEEP ≤ 0.40/8

  1. FiO2, fraction of inspired oxygen; I:E, inspiration:expiration; PaO2, partial pressure of arterial oxygen; PEEP, positive end-expiratory pressure; SpO2, oxygen saturation via pulse oximetry.