Management of Oxygenation

• 1) Escalate PEEP to 12 cm H₂0 as aggressively as possible as hemodynamics allow to optimize oxygenation, minimize FiO₂ needs, and extend oxygen supply.
• 2) Use the ARDSNet Protocol LOW PEEP table as a guide for further titration of PEEP. Refer to JTS Acute Respiratory Failure CPG.
• 3) Be prepared to start vasopressors and judicious use of IVF to support pre-load in the face of high PEEP (aka PEEP tamponade).
• 4) Consider a combination of paralysis and prone positioning early to lengthen duration of available oxygen supply.
• 5) Consider Inverse Ratio Ventilation (IRV) once patient reaches PEEP 18 cm H₂0 on the LOW PEEP table.