Fixed 2 · 26 min · fixed

Belly tight, cabin high

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

55-year-old woman, pancreatitis, IAH 22 mmHg, secondary ARDS. Long fixed-wing. Cabin scheduled 8,000 ft. Belly is a second diaphragm.

Handoff

Pplat already 29 on PEEP 12. They want her at the quaternary ICU. Gas expansion will make the belly worse. You need sea-level cabin or a smarter PEEP, not both high.

1
Treat cabin as a setting
Ask for 2,000 ft or raise FiO2 before the climb.
2
Lung Pplat ≤30 — the belly is not the lung
IAH raises measured Pplat. Hold and read ΔP lung. Do not cut a 6 mL/kg breath for chest wall.
3
Don't lose the kidney — MAP ≥ 70
High Paw + IAH = no venous return.

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