Page 442 - Clinical Application of Mechanical Ventilation

408 Chapter 12

TABLE 12-19 Calculation of Daily REE and TEE in Kilocalories

REE for men in kcal/day 5 66 113.7 W 1 5 H 2 6.8 A

REE for women in kcal/day = 655 1 9.6 W 1 1.85 H 2 4.7 A

W 5 weight in kg; H 5 height in cm; A 5 age in years
TEE for men in kcal/day 5 REE 3 Activity Factor × Stress Factor

TEE for women in kcal/day 5 REE 3 Activity Factor 3 Stress Factor
W 5 Weight in kg; H 5 Height in cm; A 5 Age in year

Activity factor

Confined to bed 31.2
Out of bed 31.3

Stress factor
Minor operation 31.20

Skeletal trauma 31.35

Major sepsis 31.60
Severe thermal burn 32.10
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ADJUNCTIVE MANAGEMENT STRATEGIES

On some occasions, the basic management strategies may not be able to maintain
proper ventilation and oxygenation. In other conditions such as acute lung injury
(ALI) and adult respiratory distress syndrome (ARDS), the ventilator settings may re-
sult in volume and pressure that may be inappropriate and detrimental to the patient.
Under these conditions, other management strategies should be considered. They
include the use of low tidal volume, prone positioning, and trachea gas insufflation.

Low Tidal Volume

Traditional tidal volume settings use 10 to 15 mL/kg of body weight and this range
is sometimes necessary to achieve normal ventilation. In one study, 48% of the
critical care practitioners reported using volumes in the range of 10–15 mL/kg and
45% reported using 5–9 mL/kg (Thompson et al., 2001). In patients with ALI or
ARDS, the inspiratory pressures (i.e., peak inspiratory and plateau) are often el-
evated due to an increased airflow resistance or/and a decreased lung compliance.
The high inspiratory pressures lead to excessive distention of the normal aerated

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