Guidelines for Complications of Cancer Treatment Vol VIII Part B

Mechanical ventilation of sepsis-induced ALI/ARDSo Noninvasive ventilation may be considered in theminority of ALI/ARDS patients with mild tomoderate hypoxemic respiratory failure. Thepatients need to be hemodynamically stable,comfortable, easily arousable, able to protect/cleartheir airway, and expected to recoverrapidly (2B) WNew Recommendation, absent in 2004 guidelinesUse a weaning protocol and an SBT regularly to evaluatethe potential for discontinuing mechanical ventilation(1A) So SBT options include a low level of pressure supportwith continuous positive airway pressure 5 cmH2O or a T piece.o Before the SBT, patients should beo Arousable, hemodynamically stableo have no new potentially serious conditionso have low ventilatory and PEEP requiremento Require FIO 2levels can be given with face maskor nasal cannula 2004 ADo not use a pulmonary artery catheter for the routinemonitoring of patients with ALI/ARDS (1A) SUse a conservative fluid strategy for patients withestablished ALI who do not have evidence of tissuehypoperfusion (1C) So New Recommendation, absent in 2004 guidelinesSedation, analgesia, and neuromuscular blockade insepsisoUse sedation protocols with a sedation goal forcritically ill mechanically ventilated patients (1B) S83