BUMC Basics.pdf - Anesthesia Home

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Higher PEEP/lower FiO2
FiO 2 0.3 0.3 0.3 0.3 0.3 0.4 0.4 0.5
PEEP 5 8 10 12 14 14 16 16
FiO
2
0.5 0.5-
0.8
0.8 0.9 1.0 1.0
PEEP 18 20 22 22 22 24
ASTHMA/COPD
Treatment of Asthma exacerbation:
1. Albuterol nebs at least 3 times in first hour, then
scheduled Q2-4 hours, plus prn nebs
2. Steroids: Either IV or PO based on severity (IV not
superior to PO). 60 mg prednisone PO qday or 1
mg/kg prednisone equivalent Q6-12 hours (at Baylor
for severe asthma exac, typically 60 mg IV solumedrol
Q6 hours) until PEFR reaches 70% predicted; then
begin taper.
3. Continue home dose of inhaled steroid if on one
4. O2 per protocol to keep SaO2 above 90%; use NPPV
if patient’s paCO2 begins to normalize or rise; also in
status asthmaticus
5. Determine severity of exacerbation and ward level
versus ICU level of care
6. Check CXR and signs of infection
Treatment of COPD exacerbation:
1. Ipratropium/Albuterol nebs Q1-2 hours to begin
2. O2 per protocol to keep SaO2 >90%
3. Steroids: IV solumedrol at 60 -125 mg IV Q6
hours (usually 60), or oral at 60 mg prednisone PO
Qday
4. Antibiotics: amoxicillin, Bactrim, doxy,
clarithromycin, levoquin (no single abx proven
superior but we typically use levaquin)
5. NPPV: Initiate early if mod/severe dyspnea,
decreased pH/high pCO2, RR>25
6. CXR
7. Smoking cessation counseling