System
Methods for Optimisation
Targets
Respiratory System
- Lung recruitment maneuvers and PEEP following apnoea test
- Continue VAP prevention measures:
- 30-45 degrees head up tilt
- Tight endotracheal cuff
- Patient positioning as per unit protocol
- Review ventilation, ensure lung protective strategy:
- Tidal volumes 4-8 ml/kg ideal body weight
- Optimum PEEP (5-10 cmH2O)
- Peak inspiratory pressures limited to <30 cmH2O
- Minimize FiO2 if lungs are to be transplanted
- Reinstate chest physiotherapy and regular suctioning
- If required perform bronchoscopy, bronchial lavage and toilet for therapeutic purposes
- Avoid high extravascular lung water:
- Early use of methylprednisolone 15 mg/kg given intravenously
- Avoid positive fluid balance
- Perform CXR (post recruitment procedure where possible)
- PaO2: 10 kPa FiO2 <0.4 as able)
- PaCO2: 5 – 6.5 kPa (or higher as long as pH >7.25)
- Tidal Volumes: 4-8 ml/kg ideal body weight
- PEEP: 5-10 cmH2O
- Peak inspiratory pressure: <30 cmH2O