Table 3.

Criteria to suspend the protocol and return to a controlled/supported mode of ventilation

(1) Surgery or invasive procedures requiring sedation

(2) Respiratory distress as defined by:

a) sustained hypoxemia (pulse oximetry oxygen saturation [SpO2] < 90%) with an FiO2 > 60% and PEEP > 10 cm H2O or hypercapnia with pH < 7.30 OR clinical respiratory distress

b) repeated episodes (≥ 3 episodes within 1 h) wherein an inspiratory pressure (drive pressure + PEEP on pressure modes or plateau pressure on volume modes) of 35 cm H2O or more is attained (despite suctioning, bronchodilation, etc.)

(3) Hemodynamic instability despite fluid boluses and requirement for high dose vasopressors: norepinephrine > 15 μg/min (0.2 μg/kg/min) or equivalent

(4) Suspected myocardial ischemia based on EKG and/or elevated Troponin I

(5) Neurologic deterioration with need to control PaCO2 (e.g. raised intracranial pressure) or central hypoventilation

(6) Respiratory rate < 10 breaths/min related to need for increased sedation

(7) PEEP ≥ 13 cm H2O

(8) FiO2 ≥ 71%

FiO₂ inspired fractional concentration of oxygen, PEEP positive end-expiratory pressure, EKG electrocardiogram