Lung Protective Ventilation

Question 1

Ventilator induced lung injury definition

Answer 1

Damage to the lungs via ventilation

Question 2

Lung protective ventilation principles (TV, CO2, PEEP)

Answer 2

Use ventilator settings that limit end expiratory volumes and pressures

• Tidal volume 6-8 mL/kg IBW
• Permissive hypercapnia (PaCO2 45-50)
• Moderate or high PEEP (5-10 cmH2O)

Question 3

Recruitment maneuvers (2 methods)

Answer 3

Sustained positive airway pressure
-Apply inspiratory pressure above 40 cmH2O
-Hold inspiration for at least 7 and ideally 40 seconds
Incrementally increase PEEP
-Start at PEEP 5, increase by 2-3 every 5 ventilations until PEEP 20
-Give more breaths at 20, continue with higher PEEP (10-12)
-Use PEEP after all recruitment maneuvers to keep recruited alveoli open

Question 4

Benefits of lung protective ventilation

Answer 4

JAMA 2012
-Decrease in lung injury
-Decrease in mortality
-Less pulmonary infection
-Shorter hospital stay
-Less atelectasis
IMPROVE Study
-Fewer major complications (pneumonia, acute respiratory failure, sepsis, death)
-Lower risk of postop acute respiratory failure (reintubation or BiPAP)
-Shorter hospitalization
-No apparent harm from protective ventilation

Question 5

Calculating ideal body weight

Answer 5

Males: 50 + 2.3(height in inches-60)
Females: 45.5 + 2.3(height in inches-60)

Question 6

Lung protective ventilator settings for care plans (TV, RR, PEEP)

Answer 6

• Calculate IBW
• TV 6-8mL/kG IBW
• Increase RR to maintain MV of 6-9L/min
• Permissive hypercarbia (PaCO2 45-50, ETCO2 ~34)
• PEEP 5-10