Table 2 Summary of mechanical ventilation procedures in the ART strategy group vs. ARDSNet strategy group
Procedure | ART strategy: maximum alveolar recruitment maneuver associated with PEEP titration | ARDSNet strategy |
|---|---|---|
Alveolar recruitment maneuver | Yes (see Figure1) | No |
Ventilation mode | Volume-controlled | Volume-controlled |
Target plateau pressure and driving pressure | Plateau ≤30 cmH2O | Plateau ≤30 cmH2O |
Target tidal volume | 4 to 6 mL/kg of predicted body weight | 4 to 6 mL/kg of predicted body weight |
Respiratory rate and pH goal | 6 to 35/min, adjusted for pH ≥ 7.30 if possible | 6 to 35/min, adjusted for pH ≥ 7.30 if possible |
I:E ratio | 1:1 to 1:2; flow 60 L/min; inspiratory pause 0.5 s | 1:1 to 1:2; flow 60 L/min; inspiratory pause 0.5 s |
Oxygenation goals | ||
PaO2 | 60 to 80 mmHg | 55 to 80 mmHg |
SpO2 | 90 to 95% | 88 to 95% |
PEEP and FiO2 adjustment | PEEP titration 2 cmH2O above PEEP value associated with maximum compliance. FiO2 titration adjusted according to oxygenation goals | According to PEEP/FiO2 combination table |
Weaning | After 24 h with PaO2/FiO2 ≥ 300 (or stable/ascending) start weaning from PEEP 2 cmH2O every 8 h. Consider pressure support ventilation after PEEP ≤ 14 cmH2O. Spontaneous ventilation test in PS = 5 cmH2O and PEEP = 5 cmH2O. Routine use of NIV immediately after extubation is encouraged | Weaning from PEEP according to table of PEEP and FiO2 combinations. Consider pressure support ventilation after PEEP ≤ 14 cmH2O. Spontaneous ventilation test in PS = 5 cmH2O and PEEP = 5 cmH2O. Routine use of NIV immediately after extubation is encouraged |