ICU Pathway for Evaluation/Treatment of Infants > 28 Days of Age and Children with Severe Sepsis

Respiratory Support

Begin Age-Appropriate Oxygen Therapy Regardless of SpO2
Indications for intubation

Initial Respiratory Assessment
Goals
Respiratory rate
Pulse oximetry
Normal for age
SpO2 92-98%,
Work of breathing Minimal, normal
Breath sounds Normal
Gas exchange:
   Monitor ABG or non-invasive TcPCO2
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SpO2 < 92%
Increased WOB
Inadequate Gas Exchange
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Consider:
Respiratory Reassessment
Goals
As above plus
Venous ScvO2
 
> 70%
Lactate < 4 mmol/L
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SpO2 < 92%
Increased WOB
Arterial pH < 7.25 ScvO2 < 70%
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Consider:
Reassess Mechanical Ventilation Goals
SpO2: 92-98%
Arterial pH > 7.25
ScvO2 > 70%
Lactate < 4 mmol/L
Follow: O2 Index (OI)
PaO2 / FiO2
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Meets Goals
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Lung-Protective Strategy
Tidal volume ≤ 8 mL/kg
PIP < 35 cm H20
FiO2 ≤ 60%
Wean FiO2 if SpO2 > 98%
Goals Not Met
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Alternative Ventilator Strategies

Oxygenation Index
Indicates severity of arterial blood hypoxemia given FiO2 and mean airway pressure provided

OI = FiO2 x MAP Values:
PaO2 Very good < 5
Medium 10-20
Poor > 25
http://www.medcalc.com/oxygen.html
Pa02/FiO2 Ratio
Indicates severity of arterial blood hypoxemia given FiO2 only, used in definitions of ALI/ARDS
Values:
Normal (95/.21) 452
Acute Lung Injury or Mild ARDS 201-300
Moderate ARDS 101-200
Severe ARDS < 100