Version May 2024
| Use small tidal volumes (eg, 6 mL/kg predicted body weight or less) in high-risk clinical settings |
| Acute respiratory distress syndrome |
| Obstructive lung disease, particularly in the presence of auto-PEEP |
| Minute ventilation >12 to 15 L/min |
| Avoid hyperventilation (ie, arterial PCO2 <40 mmHg), and consider permissive hypercapnia in circumstances listed above, unless contraindicated |
| Use PEEP cautiously in patients at increased risk for alveolar rupture |
| Acute respiratory distress syndrome |
| Obstructive lung disease (eg, COPD, asthma) |
| Unilateral, patchy, or cavitary lung disease |
| Nosocomial pneumonia or sepsis |
| Necrotizing pneumonia |
| Monitor static respiratory system compliance as PEEP is applied or increased, and back off on PEEP if compliance falls with increasing levels |
| Monitor all ventilated patients for auto-PEEP, and take specific measures to reduce auto-PEEP if its presence could be harmful to the patient: |
| Normo- or hypercapnia |
| High inspiratory flow rate (eg, 70 to 100 L/min) |
| Low-compressible-volume, low-compliance ventilator circuit |
| Wean from positive-pressure ventilation as rapidly as possible |
| Use extreme care in high-risk patients when placing subclavian or internal jugular lines or performing thoracentesis |
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