ICU Map

New ARDS Diagnosis — First 6 Hours

From recognition to lung-protective ventilation and severity-driven escalation.

RecognizeAssessDecideDifferentialInterveneReassess
New Hypoxemic Respiratory Failure
Diagnosis / EtiologyRecognize the syndromeExplore Topic
New or worsening hypoxemic respiratory failure with bilateral infiltrates, within a week of a known risk factor (pneumonia, sepsis, aspiration, transfusion, pancreatitis).
Diagnosis / EtiologyExclude a cardiac causeExplore Topic
Confirm the picture isn't fully explained by cardiac failure or fluid overload — clinical exam plus BNP/echocardiography if the risk factor isn't obvious.
Diagnosis / EtiologyGrade severityExplore Topic
Once PEEP ≥ 5 cmH2O is established, calculate PaO2/FiO2 to classify mild, moderate, or severe — this determines how aggressively to escalate.
Clinical ActionStart lung-protective ventilationExplore Topic
Set tidal volume to approximately 6 mL/kg predicted body weight and keep plateau pressure ≤ 30 cmH2O, regardless of severity grade.
Reassessment / LoopTitrate PEEP and reassess mechanicsExplore Topic
Favor a higher-PEEP strategy in moderate-to-severe disease; track driving pressure (plateau − PEEP) as you titrate, seeking lower driving pressure within an overall lung-protective approach.
Diagnosis / EtiologyConsider prone positioningExplore Topic
If PaO2/FiO2 remains < 150 despite an optimized lung-protective strategy, initiate prone positioning early — sessions of at least 16 hours per day.

An educational representation of clinical reasoning, not a diagnostic algorithm or personalized medical advice — always apply clinical judgment and institutional protocols.

Caution

Escalate — Red Flags & Critical Warnings

  • PaO2/FiO2 < 100 despite an optimized lung-protective strategy — evaluate for rescue therapy (prone positioning, neuromuscular blockade, ECMO referral).
  • New hemodynamic instability after intubation or PEEP escalation — reassess for tension physiology, right heart strain, or volume depletion before continuing to titrate PEEP.

Related Bedside Clinical Problems (10)

Bedside Presentations
Sudden Hypoxemia

Bedside triage of acute desaturation: signal verification, immediate danger screening (DOPE / tension pneumothorax), oxygen escalation ladder, and mechanism-based differential.

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Acute Hypercapnia & Ventilatory Failure

Triaging rising PaCO2: distinguishing acute uncompensated acidemia from chronic compensation, identifying central vs pump vs dead-space failure, and titrating noninvasive ventilation.

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Sudden Ventilator Deterioration & High Airway Pressures

Algorithmic troubleshooting of acute patient-ventilator collapse: the DOPE framework, peak vs plateau pressure differentiation, auto-PEEP evaluation, and manual bagging separation.

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Linked Deep-Dive Topics (4)

Reference Knowledge
Acute Respiratory Distress Syndromerespiratory

Acute, diffuse inflammatory lung injury causing hypoxemia and bilateral infiltrates not fully explained by cardiac failure or fluid overload.

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Hypoxemic Respiratory Failurerespiratory

Pathophysiologic mechanisms (shunt vs V/Q mismatch), dynamic ROX index trajectories, P-SILI prevention, and evidence-based oxygen escalation ladders.

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Invasive Mechanical Ventilationrespiratory

Complete clinical topic overview. For the full 10-level interactive course, visit Master MV. Covers core ventilator modes, respiratory mechanics (Cstat, Raw, driving pressure), waveform dyssynchrony analysis, VILI prevention, and liberation protocols.

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ECMO: Physiology, Bedside Management & Troubleshootingspecial-critical-care

Specialist-level VV/VA ECMO bedside management: selection, cannulation, gas exchange, hemodynamics, anticoagulation, circuit troubleshooting, organ support, ultrasound, ECPR, weaning and decannulation.

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Evidence status

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