Alogarithm : ARDS

The First 24 Hours After ICU Admission

ICU Admission

Target setting » protective ventilation «

(see table 1)
Recruitment potential ?
Consider HFOV
Patient hypoxaemic ? yes
PaO2 / FiO2 <60-70 with FiO2 of 1.0
ECMO if >2h
no PaO2 / FiO2 <50
Continue » protective «ventilation

Evaluate adjuvant therapies

(see table 2)

PaO2/FiO2 < 80 and PIP >35 cmH2O ECMO

yes
no

PaCO2 > 80 mmHg and/or pH <7.2

+
PIP >35 cmH2O and/or RR > 20
and/or VT >4-6 ml/kg IBW
no yes

See continuation day 2 : iLA

Continue » protective « Table 1 : Tabel 2 :
ventilation
Target setting » protective Evaluated adjuvant therapies :
ventilation« 1: (+Optimisation of ventilation parameters
(best PEEP))
PCV / (Assisted) spontaneous
 Proning therapy 2x 4-8h / 24 h
breathing
 Optimisation of haemodynamics
PIP <35 cmH2O
 Fluid management
Frequency 15-20/mm
 Treatment of the underlying disease
VT 4-6 ml/kg IBW
(e.g antibiotics)
Adequate PEEP (15-19 cmH2O)
 Pulmonary vasodilatation if pulmonary
hypertension present
Ongoing Treatment (From Day 2)
ECMO

Continue Continue » protective « ventilation

PaO2/FiO2 < 80 PaCO2 >70 mmHg Wean

PaCO2 from
<70sedation,
mmHg
Target setting » protective ventilation«
initiate spontaneus
PaO2 /FiO2 >80 PaO2 / FiO2 >80
(seeiLA
table 3) breathing
PH <7.2 (resporatory)
 Tabel 3 :

Target setting »protective ventilation« 2 :

PIP < 32 cmH2O

Delta-P 16 cmH2O
Respiratory rate 12-16/min
VT 4-6 ml/kg IBW
Adequate PEEP (10-14 cmH2O)

Sumber: modified and simplifed from Deja et al., Evidance-based Therapy of Severe Acute
Respiratory Distress Syndrome: an Algorithm-guided Approach ; The Journal of International
Medical Research, Volume 36, Number 2, March 2008, pp. 211-221 (11)