Ventilation strategies for ARDS includes PEEP, tidal volume, and plateau pressure.
Using high PEEP and initial 6 cc/kg tidal volume can cause elevated plateau pressure. If plateau pressure is above 30 with initial setting, first check to make sure there is no ventilator desynchrony that could be minimized by increasing sedation. Next decrease tidal volume to 5 and then 4 cc/kg. Decreasing TV can cause more respiratory acidosis that could be offset by increasing respiratory rate or sodium bicarb.
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