Strategies to Protect Lung Tissue from "VILI"

  • Low tidal volume ventilation (4-8 cc/kg)
  • Limit PAP (~35-40 cm H20)
  • Keep PEEP at LIP (~10-12 cm H20)
  • Use PEEP and auto-PEEP to keep FIO2 (~0.50)
  • Minimal concern in ARDS about CV effects of PEEP
  • No major concern about barotrauma effects of PEEP
  • Permit hypercapnia (keep pH > ~7.20-Avoid Bicarb)