COMMUNITY HEALTH NETWORK
SAN FRANCISCO GENERAL HOSPITAL
MEDICAL CENTER
NAME
DOB
MRN
PCP
PHYSICIAN ORDERS
Patient ID / Addressograph
ARDS Net Ventilator Orders
 VCV
Mode:
 PCV
 Auto-Flow / PRVC
 APRV
Tidal Volume: 1.) Adjust to 6 mL/kg PBW. If pt is initially at VT > 10 mL/kg, may titrate down in 1-2 mL/kg steps Q 1-2hrs
if necessary to prevent acute acidosis. 2.) When EIP > 30 cm H2O, then  VT to as low as 4 mL/kg to  EIP to < 30 cm
H2O. 3.) When pH < 7.15,  VT in 1 mL/kg steps to 8 mL/kg regardless of EIP until pH = 7.20. 4.) When severe
asynchrony occurs and sedation cannot be increased,  VT in 1 mL/kg steps to upper limit of 8 mL/kg. 5.) If EIP < 25 and
VT < 6 mL/kg,  VT back up to 6 mL/kg. 6.) When using PCV adjust PIP for VT = 6 mL/kg
Plateau Pressure (EIP): 1.) 25-30 cm H2O. 2.) EIP > 30 cm H2O allowed if PEEP > 20 cm H2O or pH < 7.20
Respiratory Rate: 1.) Set Rate 6-35. 2.) Adjust RR to maintain Minute Ventilation as VT is titrated. 3.)  RR when pH <
7.30, 4.)  RR when pH > 7.45
I:E Ratio: Set btwn 1:4 to 1:1. Inspiratory Time < 0.85 sec when RR > 30. Peak Flow Rate Target 60-75 L/min for comfort
Arterial pH: 1.) Target: 7.30-7.45, 2.) Consider Buffer Rx when pH < 7.25 AND PaCO2 < 25, 3) Modify VT/EIP goals
and Consider Buffer Rx when pH < 7.15
PEEP/FiO2 Titration: 1.) Maintain PaO2 of 55-80 mm Hg (SpO2 88-95%). Select one of the PEEP FiO2 Tables below
 ARDS Net ARMA Trial PEEP/FiO2 Table
FiO2
PEEP
0.30
5
0.40
5-8
0.50
8-10
.60
10
.70
10-14
.80
14
.90
14-18
1.0
18-26
 ARDS Net ALVEOLI Trial PEEP/FiO2 Table
FiO2
PEEP
0.30
5-8
0.40
8-10
0.50
10-16
.60-.70
16
.70-.80
18
.90
18-20
1.0
20-26

Free Form PEEP: Maintain PEEP at ________cm H2O and Titrate FiO2 for Protocol PaO2/SpO2 range

PEEP/ FiO2 according to Recruitment Maneuver: see RM titration orders on ___/___/_____
 Alternative Arterial Blood Gas Ranges: For patients concurrently managed on the TBI protocol, or patients with or at risk
for myocardial or GI ischemia, Please specifiy alternative ranges by which to adjust PEEP, FiO2 and RR:
PaO2 range:
PaCO2 Range
pH Range
Mandatory Arterial Blood Gases: 1.) Protocol initiation at VT = 6 mL/Kg. 2.) Every day, first 7 days of protocol. 3.) Severe
acidosis (pH < 7.15) after VT  to 7 and 8 mL/Kg. 3.) PEEP ↑ > 10 cm H2O. 4.) Check SpO2 or PaO2 at least Q4o and < 30
min after adjustments in PEEP/FiO2. Vd/Vt on protocol initiation, with PEEP titration and other ventilator adjustments at RCP
or MD discretion (when NICO monitor is available).
Weaning: Use Spontaneous Breathing Protocol once weaning readiness criteria are met. A separate SBT order sheet must
be used.
Date:
Time
CHN#
Date:
Time
Unit Clerk Signature:
Date:
Time
RN Signature:
Date:
Time
Signature:
Revised 6/1/2012
Signature:
Pager#: