Table 1 Perils that ensue upon making a diagnosis of ARDS
Protocol mandate | Physiologic consequences | Clinical problems |
|---|---|---|
Prescription of tidal volume 6 ml/kg in all patients, irrespective of plateau pressure | Severe air hunger ensues when delivered tidal volume does not match heightened stimulation of sensory receptors | Sedatives, opiates, and paralytic agents do not allay air hunger but contribute to complications |
If mechanical inspiratory time is shorter than neural inspiratory time, double triggering is inevitable | Despite adjusting a ventilator to deliver 6 ml/kg, the patient actually receives 12 ml/kg | |
Fixed PEEP options | Constraints imposed by use of PEEP-FIO2 table | If FIO2 is 0.60: patient got either PEEP 10 or 20 cm H2O with no other options If FIO2 is 0.80: patient got either PEEP 14 or 22 cm H2O with no other options |