2.3

• VALI


  Ventilator-associated lung injury
• Causes of VALI in ARDS

  • Alveolar over-distention
  • Cyclic atelectasis
• Open Lung Strategy


  Mechanical ventilation strategy that combines low tidal volumes with PEEP to maximize alveolar recruitment and avoid over-distention
• Keep plateau pressures less than 30 cm H2O
• Why plateau pressures must be maintained at a particular level

  To prevent alveolar over-distention
• Lung protective strategies for patients with ARDS

  • Small tidal volumes (4-6 ML/KG OF IBW)
  • Limited Pplat (<30CMH20)
  • Appropriate PEEP application
• Benefits of High PEEP strategy

  • Can improve oxygenation in pts with a recruitable lung
  • May open collapsed alveoli and decrease alveolar distention bc of the numerous alveoli being ventilated
  • Evidence shows that it can improve oxygenation, increase vent-free days and lower ICU mortality
• Harmful effects of High PEEP strategy

  • Harmful in pts with mild ARDS
  • Avoid as INITIAL strategy
  • May cause barotrauma or VALI
  • May decrease venous return and reduce cardiac output
• When performing a recruitment maneuver

  The RT must monitor the patient's heart rate, blood pressure, and cardiac monitor for development of arrhythmias
• Contraindications of prone position

  • Shock
  • Hemorrhage
  • Multiple fracture or trauma
  • Spinal instability
  • Pregnancy
  • Increased ICP
  • Recent sternotomy
• Bronchial hygiene techniques that may improve oxygenation in ventilated patients


  • Suctioning and airway care
  • Ensuring humidification
  • Admin bronchodilator and inhaled anti-inflammatory agents
• PF Ratio


  A measurement that assesses severity of ARDS, PaO2/ FiO2
• Ranges of ARDS severity

  • Normal >300
  • Mild (ALI) 200-300
  • Moderate 100-199
  • Severe <100
• Oxygen Index equation


  OI= FiO2 * MAP / PaO2 * 100