Anesthesia Considerations 

Sepsis-induced ARDS Ventilation Strategies 

 

 

• Use tidal volumes of 6cc/kg 

• Pleateau pressure <30 cm H2O

• Use PEEP to avoid alveolar collapse & titrate ↑ as needed 

• Use recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS

• Consider prone positioning in sepsis-induced ARDS patients with a Pao2/Fio2ratio ≤ 100mm Hg 

• Head of the bed elevated between 30-45º to reduce aspiration risk & to prevent the development of VAP

• Consider noninvasvie ventilation (NIV) if thought to be more beneficial than intubation.  But no strong recommendation to use NIV

• Use neuromuscular blocking agents (NMBAs) for ≤ 48 hours in adult patients with sepsis-induced ARDS & Pao2/Fio2 ratio < 150mm Hg (possible ↑ survival & ↓ barotrauma) 

• Establish weaning protocols & allow for frequent spontaneous breathing trials to eventually discontinue mechanical ventilation once the patient meets extubation criteria 

• 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