Shenandoah University acute Respiratory Distress Syndrome Protocol Capstone Dear,I need help writing a full formal protocol for ARDS patients, I have this

Shenandoah University acute Respiratory Distress Syndrome Protocol Capstone Dear,I need help writing a full formal protocol for ARDS patients, I have this updated study to use as guidelines. I need it for my hospital as a protocol.I am a respiratory therapist PART I: VENTILATOR SETUP AND ADJUSTMENT
1. Calculate predicted body weight (PBW)
Males = 50 + 2.3 [height (inches) – 60]
Females = 45.5 + 2.3 [height (inches) -60]
2. Select any ventilator mode
3. Set ventilator settings to achieve initial VT = 8 ml/kg PBW
4. Reduce VT by 1 ml/kg at intervals ≤ 2 hours until VT = 6ml/kg PBW.
5. Set initial rate to approximate baseline minute ventilation (not > 35
bpm).
6. Adjust VT and RR to achieve pH and plateau pressure goals below.
INCLUSION CRITERIA: Acute onset of
1. PaO2/FiO2 ≤ 300 (corrected for altitude)
2. Bilateral (patchy, diffuse, or homogeneous) infiltrates consistent with
pulmonary edema
3. No clinical evidence of left atrial hypertension
NIH NHLBI ARDS Clinical Network
Mechanical Ventilation Protocol Summary
ARDSne t
0.5
18
0.5-0.8
20
0.8
22
0.9
22
0.3
14
0.9
18
0.5
10
1.0
22
0.4
14
1.0
18-24
0.6
10
1.0
24
0.4
16
0.7
10
0.5
16
0.7
12
__________________________________________________________
PLATEAU PRESSURE GOAL: ≤ 30 cm H2O
Check Pplat (0.5 second inspiratory pause), at least q 4h and after each
change in PEEP or VT.
If Pplat > 30 cm H2O: decrease VT by 1ml/kg steps (minimum = 4
ml/kg).
If Pplat 25 cm H2O or VT = 6 ml/kg.
If Pplat 7.30 or PaCO2
7.15 (Pplat target of 30 may be exceeded).
May give NaHCO3
Alkalosis Management: (pH > 7.45) Decrease vent rate if possible.
______________________________________________________
I: E RATIO GOAL: Recommend that duration of inspiration be 120% of baseline
Marked accessory muscle use
Abdominal paradox
Diaphoresis
Marked dyspnea
3. If tolerated for at least 30 minutes, consider extubation.
4. If not tolerated resume pre-weaning settings.
(2019) 9:69
Papazian et al. Ann. Intensive Care
https://doi.org/10.1186/s13613-019-0540-9
Open Access
REVIEW
Formal guidelines: management of acute
respiratory distress syndrome
Laurent Papazian1*, Cécile Aubron2, Laurent Brochard3, Jean-Daniel Chiche4, Alain Combes5, Didier Dreyfuss6,
Jean-Marie Forel1, Claude Guérin7, Samir Jaber8, Armand Mekontso-Dessap9, Alain Mercat10,
Jean-Christophe Richard11, Damien Roux6, Antoine Vieillard-Baron12 and Henri Faure13
Abstract
Fifteen recommendations and a therapeutic algorithm regarding the management of acute respiratory distress
syndrome (ARDS) at the early phase in adults are proposed. The Grade of Recommendation Assessment, Development and Evaluation (GRADE) methodology has been followed. Four recommendations (low tidal volume, plateau
pressure limitation, no oscillatory ventilation, and prone position) had a high level of proof (GRADE 1 + or 1 −); four
(high positive end-expiratory pressure [PEEP] in moderate and severe ARDS, muscle relaxants, recruitment maneuvers, and venovenous extracorporeal membrane oxygenation [ECMO]) a low level of proof (GRADE 2 + or 2 −); seven
(surveillance, tidal volume for non ARDS mechanically ventilated patients, tidal volume limitation in the presence of
low plateau pressure, PEEP > 5 cmH2O, high PEEP in the absence of deleterious effect, pressure mode allowing spontaneous ventilation after the acute phase, and nitric oxide) corresponded to a level of proof that did not allow use of
the GRADE classification and were expert opinions. Lastly, for three aspects of ARDS management (driving pressure,
early spontaneous ventilation, and extracorporeal carbon dioxide removal), the experts concluded that no sound
recommendation was possible given current knowledge. The recommendations and the therapeutic algorithm were
approved by the experts with strong agreement.
Introduction
Acute respiratory distress syndrome (ARDS) is an inflammatory process in the lungs that induces non-hydrostatic
protein-rich pulmonary oedema. The immediate consequences are profound hypoxemia, decreased lung compliance, and increased intrapulmonary shunt and dead
space. The clinicopathological aspects include severe
inflammatory injury to the alveolar-capillary barrier, surfactant depletion, and loss of aerated lung tissue.
The most recent definition of ARDS, the Berlin definition, was proposed by a working group under the
aegis of the European Society of Intensive Care Medicine [1]. It defines ARDS by the presence within 7 days
of a known clinical insult or new or worsening respiratory symptoms of a combination of acute hypoxemia
*Correspondence: Laurent.PAPAZIAN@ap-hm.fr
1
Service de Médecine Intensive – Réanimation, Hôpital Nord, Chemin des
Bourrely, 13015 Marseille, France
Full list of author information is available at the end of the article
(PaO2/FiO2 ≤ 300 mmHg), in a ventilated patient with
a positive end-expiratory pressure (PEEP) of at least
5 cmH2O, and bilateral opacities not fully explained
by heart failure or volume overload. The Berlin definition uses the PaO2/FiO2 ratio to distinguish mild
ARDS (200