Management of Acute Respiratory Failure from Acute Lung Injury and Acute Respiratory Distress Syndrome - Flowchart

Management of Acute Respiratory Failure from Acute Lung Injury and Acute Respiratory Distress Syndrome - Flowchart

Management of Acute Respiratory Failure from Acute Lung Injury and Acute Respiratory Distress Syndrome - Flowchart Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome

«Flowchart»

Management of acute respiratory failure from acute lung injury and acute respiratory distress syndrome

Management of acute respiratory failure from acute lung injury and acute respiratory distress syndrome

Management of acute respiratory failure from acute lung injury and acute respiratory distress syndrome

Management of acute respiratory failure from acute lung injury and acute respiratory distress syndrome

Place on non-rebreathing mask with 100% O₂
Attach pulse oximeter for SpO₂ and measure arterial blood gases

Place on non-rebreathing mask with 100% O₂
Attach pulse oximeter for SpO₂ and measure arterial blood gases

Place on non-rebreathing mask with 100% O₂
Attach pulse oximeter for SpO₂ and measure arterial blood gases

₂
₂

Begin management of precipitating events including antibiotics for infection and work-up for possible sources of infection
Consider two-dimensional echocardiogram to evaluate cardiac function

Begin management of precipitating events including antibiotics for infection and work-up for possible sources of infection
Consider two-dimensional echocardiogram to evaluate cardiac function

Begin management of precipitating events including antibiotics for infection and work-up for possible sources of infection
Consider two-dimensional echocardiogram to evaluate cardiac function

Adjust FiO₂ to yield SpO₂ 88-95% Consider high flow nasal oxygen or NIPPV to treat respiratory failure

Adjust FiO₂ to yield SpO₂ 88-95% Consider high flow nasal oxygen or NIPPV to treat respiratory failure

Adjust FiO₂ to yield SpO₂ 88-95% Consider high flow nasal oxygen or NIPPV to treat respiratory failure

₂ ₂

Patient alert and hemodynamically stable: RR <35, PaCO₂ <35 mm Hg; SpO₂ >88%

Patient alert and hemodynamically stable: RR <35, PaCO₂ <35 mm Hg; SpO₂ >88%

Patient alert and hemodynamically stable: RR <35, PaCO₂ <35 mm Hg; SpO₂ >88%

CO₂ ₂ ₂

Yes

Yes

Yes

No

No

No

End

End

End

Decrease V_T to 5 mL/kg or (if needed) 4 mL/kg to achieve Pplat <30 cm H₂O if pH > 7.25

Decrease V_T to 5 mL/kg or (if needed) 4 mL/kg to achieve Pplat <30 cm H₂O if pH > 7.25

Decrease V_T to 5 mL/kg or (if needed) 4 mL/kg to achieve Pplat <30 cm H₂O if pH > 7.25

_T _T ₂

Consider neuromuscular blockade, inhaled nitric oxide, and prone position

Consider neuromuscular blockade, inhaled nitric oxide, and prone position

Consider neuromuscular blockade, inhaled nitric oxide, and prone position

Consider intubation: volume cycled assist control ventilation: V_T 6 mL/kg PBW; use ARDSNet lung protective ventilation guidelines with PEEP and FiO₂ scale; conscious sedation as needed; DVT prophylaxis; semi-recumbent (45°) position

Consider intubation: volume cycled assist control ventilation: V_T 6 mL/kg PBW; use ARDSNet lung protective ventilation guidelines with PEEP and FiO₂ scale; conscious sedation as needed; DVT prophylaxis; semi-recumbent (45°) position

Consider intubation: volume cycled assist control ventilation: V_T 6 mL/kg PBW; use ARDSNet lung protective ventilation guidelines with PEEP and FiO₂ scale; conscious sedation as needed; DVT prophylaxis; semi-recumbent (45°) position

_T _T ₂

Pplat >30 cm H₂O

Pplat >30 cm H₂O

₂ Pplat >30 cm H(2)O

Severe ARDS (P/F <100 mm Hg)

Severe ARDS (P/F <100 mm Hg)

Severe ARDS (P/F <100 mm Hg)

pH <7.25

pH <7.25

pH <7.25

Consider bicarbonate infusion and CVVH to manage acidosis

Consider bicarbonate infusion and CVVH to manage acidosis

Consider bicarbonate infusion and CVVH to manage acidosis

If still P/F <100 mm Hg

If still P/F <100 mm Hg

If still P/F <100 mm Hg

Consider ECMO

Consider ECMO

Consider ECMO