Patient handout

Mechanical Ventilation Management

PRODUCTION

1. Your condition

This handout is for mechanical ventilation management. Your care team identified this based on: type i (hypoxemic) respiratory failure — pao2 <60 mmhg on room air or p/f <300 (ats/esicm/sccm 2024).

Other reasons your team may use this plan: type ii (hypercapnic) respiratory failure — paco2 >50 mmhg with ph <7.35 (ats/esicm/sccm 2024); airway protection required — gcs <=8 or inability to protect airway (ats/accp sbt 2017); hemodynamic shock with respiratory compromise requiring intubation (ssc 2021).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
AC_VC_lung_protective_settings	VT 6 mL/kg PBW (range 4-8), RR 14-22 (titrate to pH >=7.20), PEEP per ARDSNet low/high table, FiO2 titrate to SpO2 88-95%, Pplat <30 cmH2O, dP <15 cmH2O	invasive_ventilator	continuous	ARDSNet ARMA (Brower NEJM 2000) — VT 6 mL/kg PBW reduced mortality 9% vs 12 mL/kg; permissive hypercapnia accepted

Plan: Ventilator mode selection and lung-protective strategy (ATS/ESICM/SCCM 2024; ARDSNet Brower NEJM 2000)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Refractory hypoxemia P/F <100 despite optimized lung-protective ventilation, prone positioning, and adequate PEEP (ATS/ESICM/SCCM 2024)(life-threatening)
Tension pneumothorax in ventilated patient — sudden hypoxia, hypotension, elevated peak pressures, absent breath sounds (ATS/ESICM/SCCM 2024)(life-threatening)
New or worsening infiltrate + fever/leukocytosis + purulent secretions in patient ventilated >=48h (ATS/IDSA VAP 2016)
Reintubation within 48h of planned extubation — indicates weaning failure or upper airway obstruction (ATS/ACCP SBT 2017)
Plateau pressure >30 cmH2O despite VT 6 mL/kg PBW and adequate sedation (ARDSNet Brower NEJM 2000)

5. Follow-up

Post-extubation monitoring (stridor, reintubation risk), tracheostomy evaluation if ventilation >14 days, post-ICU syndrome screen (cognitive, physical, mental health), pulmonary rehab referral (ATS/ACCP SBT 2017; SCCM post-ICU 2020)

6. Sources

Guideline: ATS/ESICM/SCCM 2024 Mechanical Ventilation Guideline + ARDSNet ARMA (Brower NEJM 2000) + ATS/ACCP SBT Guidelines 2017 + SCCM PADIS Guidelines 2018