Mechanical Ventilation Monitoring and Management

Ventilator Settings and Lung Protection

The American Thoracic Society recommends maintaining plateau pressure (Pplat) ≤30 cmH₂O to prevent complications and improve outcomes in mechanically ventilated patients with ARDS, with a strong recommendation and moderate confidence 1, 4
The American College of Chest Physicians suggests that driving pressure (plateau pressure minus PEEP) must be partitioned from total pressure, as it represents a major mortality risk factor 3
The European Society of Intensive Care Medicine recommends monitoring mean airway pressure, as it directly affects pulmonary vascular resistance and right ventricular afterload 2, 5
The American Thoracic Society recommends lung-protective ventilation with tidal volume at 4-8 ml/kg predicted body weight 1, 3

The Society of Critical Care Medicine recommends monitoring central venous pressure trends to assess RV function response to treatment, rather than using it as an absolute filling pressure target 5
The American College of Cardiology suggests using echocardiography to detect acute cor pulmonale, which occurs in 20-25% of ARDS cases and requires immediate ventilator adjustment 5, 6
The European Society of Intensive Care Medicine recommends using pulse pressure variation >13% during passive ventilation with tidal volume ≥8 ml/kg to predict fluid responsiveness 5

The American Association for Respiratory Care recommends calculating static compliance (tidal volume divided by plateau pressure minus PEEP) to assess lung distensibility 3
The American Thoracic Society suggests using the rapid shallow breathing index (respiratory rate divided by tidal volume in liters) to predict weaning success when <105 breaths/min/L 3