HW Tip Sheet Front

8 ml Height Inches kg PBW

4' 6" 54 290 4' 7" 55 310 4' 8" 56 330 4' 9" 57 350 4' 10" 58 370 4' 11" 59 380 5' 0" 60 400 5' 1" 61 420 5' 2" 62 440 5' 3" 63 460 5' 4" 64 480 5' 5" 65 490 5' 6" 66 510 5' 7" 67 530 5' 8" 68 550 5' 9" 69 570 5' 10" 70 590 5' 11" 71 600 6' 0" 72 620 6' 1" 73 640 6' 2" 74 660 6' 3" 75 680 6' 4" 76 700

Male

6 ml

kg PBW

220 230 250 260 270 290 300 320 330 340 360 370 390 400 410 430 440 450 470 480 500 510 520

4 ml

kg PBW

150 160 170 170 180 190 200 210 220 230 240 250 260 270 280 290 290 300 310 320 330 340 350

Female

8 ml

6 ml

4 ml

kg PBW kg PBW kg PBW

260 190 130 270 210 140 290 220 150 310 230 160 330 250 170 350 260 180 370 280 180 380 290 190 400 300 200 420 320 210 440 330 220 460 340 230 480 360 240 500 370 250 510 390 260 530 400 270 550 410 280 570 430 290 590 440 290 610 450 300 620 470 310 640 480 320 660 500 330

King County Lung Injury Project Height and Weight Tidal Volume Conversion Chart

Tips for using lung protective ventilation in acute lung injury

? Set tidal volume according to predicted body weight (PBW) based on height and gender. Use tables or formulas ? do not use measured weight. Predicted Body Weight Male=50+2.3(height (in.)-60)

Predicted Body Weight Female=45.5+2.3(height (in.)-60)

? Use airway pressure at end-inspiration (plateau or static pressure) to adjust tidal volume. Initiate lung protective ventilation at 8 ml/kg PBW and reduce slowly to 6 ml/kg PBW target. Peak airway pressure is not used to adjust flow rate or tidal volume. Reduce tidal volume further if plateau pressure is > 30 cm H2O until 4 ml/kg PBW. May increase tidal volume if plateau pressure is < 30 cm H2O until 6 ml/kg PBW.

? Static pressures may go above 30 cm H2O if Tidal volume is down to the minimum 4 ml/kg PBW. Tidal volumes greater than 6 ml/kg PBW are needed to manage severe acidosis. Oxygenation goals cannot be met with other methods.

? If you choose to use pressure control ventilation to deliver lung protective ventilation. Pressure oriented modes of ventilation have not been shown to improve outcome compared to volume modes of ventilation in acute lung injury. Keep pressure control + total PEEP < 30 and the delivered tidal volume < 6 ml/kg PBW. If the tidal volume increases during pressure control ventilation, then the pressure setting must be decreased until the delivered tidal volume < 6 ml/kg PBW.

? Things to expect when you use lung protective ventilation and what to do about them

Tachypnea Discomfort

Tolerate respiratory rates up to 40 if not sustained. Important to distinguish tachypnea due to small tidal volumes from discomfort and

ventilator dysynchrony.

Increased sedation may be necessary during lung protective ventilation Tachypnea alone is not a reliable sign of discomfort during lung protective ventilation

?use other signs (grimacing, nasal flaring, oxygenation) in addition to respiratory rate to assess comfort and need for sedation.

Ventilator dysynchrony "Stacking"

Worsening ventilation

Consider autoPEEP, inadequate inspiratory flow rate, trigger sensitivity, circuit water, suctioning, pneumothorax, bronchospasm.

After excluding these problems, either tolerate occasional breath stacking or increase sedation.

Paralysis is rarely, if ever, needed to treat ventilator dysynchrony. Although rarely necessary, if frequent (> 6/minute) stacking does not resolve with the

above, try small (50ml) increments in tidal volume (may exceed 6 ml/kg PBW as long as Pplat < 30). When stable, reduce tidal volume back to 6 ml/kg PBW.

Elevated PaCO2 (hypercapnea) is common during lung protective ventilation. Tolerate pH to 7.15 as long as no cardiovascular complications are present

Initiation of lung protective ventilation can be challenging, and many clinicians give up on the therapy because oxygenation worsens. Reductions in tidal volume should proceed slowly (e.g. over 2 hrs) ? particularly with initial tidal volume reduction and when oxygenation and pH are marginal. (See order sheet.)

Worsening Increased PEEP may be needed when tidal volumes are reduced. oxygenation Serial reductions in tidal volume and increases in PEEP may be necessary until the

patient is stabilized with adequate oxygenation and acceptable tidal volume.

PaO2 > 55 or SaO2 > 88% is acceptable and provides adequate oxygenation A common and acceptable arterial blood gas during lung protective ventilation is pH

7.27, PaCO2 62, PaO2 58

? Weaning can begin when patients are on < 40% FiO2 and < 8 cm H2O PEEP with PaO2 > 60. If oxygenation worsens, then patients need to return to lung protective ventilation.

? 2002 Ki C L I j P j

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