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Table 1 Ventilator settings with the two ventilation strategies

From: PReVENT - protective ventilation in patients without ARDS at start of ventilation: study protocol for a randomized controlled trial

  Lower tidal volume ventilation Higher tidal volume ventilation
Ventilator mode Assisted MV = volume- controlled Assisted MV = volume-controlled
Spontaneous MV = pressure support Spontaneous MV = pressure support
Target tidal volume 4 ml/kg PBW 10 ml/kg PBW
Allowable tidal volume in case of high pressures (in the high tidal group) or severe dyspnea (in the low tidal group) 6 ml/kg PBWa 8 ml/kg PBWa
Allowable ventilator rate setting needed to achieve normal pH (7.25 to 7.45) 6 to 35 breaths/minute; typically higher than with an higher tidal volume 6 to 35 breaths/minute; typically lower than with a lower tidal volume
Inspiration-to-expiration ratio 1:2 1:2
PaO2 or SpO2-targets 7.3 to 10.7 kPa (55 to 80 mmHg), or 90 to 92 % 7.3 to 10.7 kPa (55 to 80 mmHg), or 90 to 92 %
Allowable combinations of FiO2 and PEEP 0.21 and 5 cmH2O 0.21 and 5 cmH2O
0.30 and 5 cmH2O 0.30 and 5 cmH2O
0.40 and 5 cmH2O 0.40 and 5 cmH2O
0.40 and 8 cmH2O 0.40 and 8 cmH2O
0.50 and 8 cmH2O 0.50 and 8 cmH2O
0.50 and 10 cmH2O 0.50 and 10 cmH2O
0.60 and 10 cmH2O 0.60 and 10 cmH2O
Daily assessment of the ability to breathe with pressure support Required when FiO2 ≤ 0.4 or earlier Required when FiO2 ≤ 0.4 or earlier
Allowable tidal volume when ARDS develops 6 ml/kg PBW 6 ml/kg PBW
Allowable tidal volume when ARDS develops; in case of severe dyspnea or unacceptable pH 8 ml/kg PBW 8 ml/kg PBW
Allowable combinations of FiO2 and PEEP (continued) 0.21 and 5 cmH2O 0.21 and 5 cmH2O
  0.30 and 5 cmH2O 0.30 and 5 cmH2O
  0.40 and 5 cmH2O 0.40 and 5 cmH2O
  0.40 and 8 cmH2O 0.40 and 8 cmH2O
  0.50 and 8 cmH2O 0.50 and 8 cmH2O
  0.50 and 10 cmH2O 0.50 and 10 cmH2O
  0.60 and 10 cmH2O 0.60 and 10 cmH2O
  0.70 and 10 cmH2O 0.70 and 10 cmH2O
  0.70 and 12 cmH2O 0.70 and 12 cmH2O
  0.70 and 14 cmH2O 0.70 and 14 cmH2O
  0.80 and 14 cmH2O 0.80 and 14 cmH2O
  0.90 and 14 cmH2O 0.90 and 14 cmH2O
  0.90 and 16 cmH2O 0.90 and 16 cmH2O
  0.90 and 18 cmH2O 0.90 and 18 cmH2O
  1 and 18 cmH2O 1 and 18 cmH2O
  1 and 20 cmH2O 1 and 20 cmH2O
  1 and 22 cmH2O 1 and 22 cmH2O
  1 and 24 cmH2O 1 and 24 cmH2O
  1. awith pressure support tidal volumes could be higher than targeted with the lowest possible pressure support level, or lower than targeted with the highest allowed maximum airway pressure - this is accepted and never a reason for use of (more) sedation, paralytic agents, and/or switch to a controlled mode of ventilation
  2. ARDS acute respiratory distress syndrome, FiO 2 O2–fraction of inspired air, MV mechanical ventilation, PBW predicted body weight, PEEP positive end-expiratory pressure, SpO 2 peripheral O2 saturation