Lung-protective ventilation sets tidal volume at about 6 mL per kg of predicted body weight, which depends on height and sex, not on what the patient weighs. Using actual weight in a patient with obesity can give a tidal volume far too large for their lungs.
Measure or estimate height at intubation, calculate predicted body weight, and write the target tidal volume on the chart. Plateau pressure below about 30 cmH2O is the standard check.
- Record height at intubation so predicted body weight can be calculated.
- Start at about 6 mL/kg predicted body weight in patients with or at risk of ARDS.
- Check plateau pressure and keep it below about 30 cmH2O.
- Recalculate if the initial height was a guess.
Why it matters
The commonest error in lung-protective ventilation is using the wrong weight.
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