AirCare 1 · 22 min · rotor

Viral ARDS — night rotor

ARDSNet ARMA / ALVEOLI · ATS 2024 · 88–95% (ARDSNet ARMA; PaO2 55–80 mmHg) · ARDSNet / SSC: 6 mL/kg PBW; drop 1 mL/kg toward 4 if Pplat >30 · Pplat ≤30 · ΔP ≤14 (trainer) · PaCO2 ~35–45

61-year-old man, day 4 viral pneumonia. Proned overnight, now too unstable for the truck. P/F 96 on PEEP 14 / FiO2 80 (Berlin severe). Flight plan 22 minutes, cabin will step to ~4,000 ft.

Handoff

Unit vent: VT 6 mL/kg PBW, PEEP 14, FiO2 80, Pplat 29. They want you on the T1 in ASV. Do not. Height/sex first (180 cm male → PBW ~75 kg). PCV+ or (S)CMV+. ARDSNet table — PEEP 14 / FiO2 80 is the lower-table pair. Climb is a table step, not a sat of 100.

1
ARDSNet VT 6 mL/kg PBW — drop toward 4 if Pplat >30
180 cm male ≈ 75 kg. 6 mL/kg ≈ 450 mL. Cstat ~22 cannot take 450 at PEEP 14 without Pplat >30 — live at 4–6.
2
PEEP/FiO2 on the ARDSNet table — do not drop to 5
Lower table at FiO2 0.80 = PEEP 14. Higher table (severe) = PEEP 20–22 if MAP allows. No 40-second hold.
3
SpO2 88–95% (PaO2 55–80) — treat the climb as a table step
Raise FiO2 before lift. Then walk PEEP with the table. 100% all the way in is not the goal.

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