Sepsis-induced ARDS Ventilation Strategies
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Use tidal volumes of 6cc/kg
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Pleateau pressure <30 cm H2O
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Use PEEP to avoid alveolar collapse & titrate ↑ as needed
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Use recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS
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Consider prone positioning in sepsis-induced ARDS patients with a Pao2/Fio2ratio ≤ 100mm Hg
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Head of the bed elevated between 30-45º to reduce aspiration risk & to prevent the development of VAP
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Consider noninvasvie ventilation (NIV) if thought to be more beneficial than intubation. But no strong recommendation to use NIV
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Use neuromuscular blocking agents (NMBAs) for ≤ 48 hours in adult patients with sepsis-induced ARDS & Pao2/Fio2 ratio < 150mm Hg (possible ↑ survival & ↓ barotrauma)
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Establish weaning protocols & allow for frequent spontaneous breathing trials to eventually discontinue mechanical ventilation once the patient meets extubation criteria
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If absence of hypoperfusion & need for fluid resuscitation, use a conservative fluid strategy
Adapted from Surviving Sepsis Guidelines 2016. Critical Care Medicine: March 2017 - Volume 45, Issue 3, p 486–552