What “current” means on this trainer (2026)

Every score and coach line calls one function: guideCategory. ARDS / contusion → ARDSNet. Inhalation → FiO2 100% while CO is plausible, then the table. Sepsis → SSC. Kids → PALICC-2. ROSC → AHA 2025. TBI → BTF. COPD → BTS. Pregnancy → PaCO2 30–34. DKA → match MV, then wean to 6. Asthma is not COPD. ΔP ≤14 is this trainer’s Amato line, not an ATS mandate. Not a Hamilton protocol.

Lung protection, all patients

Adults: VT 6 mL/kg predicted body weight (range 4–8). Plateau ≤ 30. Driving pressure ≤ 14 is how this trainer scores adults (Amato association — not an ATS strong recommendation). Default start is 6, not 8.

PALICC-2 (children)

Start 6–8 mL/kg if PIP ≤ 28 or ΔP ≤ 15. If you cannot stay in those pressures, cut to 4–6 mL/kg. SpO2 92–97%. In severe PARDS, 88–92% is acceptable if PEEP is already optimized. Do not paste adult 6–7 / ΔP 14 onto a child.

Oxygen

Condition-specific. ARDS / contusion: ARDSNet 88–95 or PaO2 55–80. Sepsis: SSC conservative 88–95. ROSC: AHA 2025 100% until a sat, then 90–98. COPD: BTS 88–92. Asthma: trainer 92–96 — not a retainer. Kids: PALICC-2 92–97. Inhalation: FiO2 100% while CO is plausible (pulse ox lies), then the ARDSNet table. Other adults: this trainer 92–96 to avoid hyperoxia — not BTS 94–98.

ARDS (ARDSNet ARMA / ALVEOLI)

VT 6 mL/kg PBW. If Pplat >30, cut VT 1 mL/kg toward 4. Pplat ≤30. Rate for pH 7.30–7.45, max 35. I:E 1:1–1:3. SpO2 88–95 or PaO2 55–80. PEEP is a pair with FiO2: lower table (ARMA) or higher table (ALVEOLI) for moderate–severe. Example: FiO2 0.80 → PEEP 14 on the lower table, PEEP 20–22 on the higher table. ATS 2024: no 40-second recruitment hold. Contusion is focal ARDS — same table.

Sepsis (SSC 2021)

Same 6 mL/kg and Pplat ≤30. Conservative oxygen — this trainer scores 88–95%. MAP ≥65. Do not treat septic shock with the ALVEOLI high table if the RV is empty.

Pregnancy

PBW from height, not gravid weight. PaCO2 30–34 is her baseline — 40 is relative hypoventilation. MAP ≥70 and left uterine displacement. FRC is already down; raise FiO2 before climb. Physiology, not an obstetric T1 protocol.

DKA / metabolic

Match pre-intubation minute ventilation first. 7–8 mL/kg is allowed only while pH <7.20. When pH turns, wean to 6. Rate first, not a 10 mL/kg breath.

Inhalation / CO

High FiO2 until a CO-oximeter says otherwise. Then it is ARDS with soot: table PEEP, 6 mL/kg, Pplat ≤30. Pulse ox is a liar while CO is high.

Spontaneous breathing and NMB

Prefer early assisted / SPONT when drive returns. Neuromuscular blockade is conditional and short-term in early severe ARDS — not a flight-length default.

ASV

On the T1 so you can recognize a sending-facility choice. Flight Crew Buddy does not fly ASV as the default. Set IBW, pick PCV+ or (S)CMV+, and own rate and VT from the lung, the sedation, and the gas.

TBI / ICP (BTF 4th ed.)

Normocapnia is PaCO2 35–45. Do not prophylactically hyperventilate to ≤25 — that is associated with ischemia, especially in the first 24 hours. Hyperventilation is a short bridge for a new herniation, then back to 35–45. A sending facility that wants 35–38 is a house convention, not BTF. This trainer no longer fails you at 39.