Table 1 Intervention protocol

PaO₂

 < 10 kPa first time

Increase FiO₂ to 0.6

PaO₂

 < 10 kPa after that

1. Increase FiO₂ 0.6 → 0.8 → 1.0

AND

2. Increase PEEP 5 → 8 → 10 → 14 cm H₂O

AND

3. Lung recruitment manoeuvre

PaO₂

 > 30 kPa

Decrease FiO₂ to next level 1.0 → 0.8 → 0.6 → 0.3

MAP and/or CI

MAP < 60 mm Hg and/or CI < 2.0 L × min⁻² × m⁻²

Start norepinephrine infusion 0.07 µg × kg⁻¹ × min⁻¹. If ongoing norepinephrine infusion, increase the rate one step: 0.07 → 0.13 → 0.29 → 0.54 µg × kg⁻¹ × min⁻¹and measure cardiac output. If CO < 2.5 L x min⁻¹, give a bolus dose of acetated Ringer's 15 mg × kg⁻¹

MAP

MAP = MPAP (at < 90 min after baseline)

A single dose of 40 µg norepinephrine, i.v

Repeat if needed

MAP

MAP = MPAP (at > 90 min after baseline)

1. A single dose of 20 µg norepinephrine, i.v

AND

2. Start norepinephrine infusion 0.07 µg × kg⁻¹ × min⁻¹. If ongoing, increase rate one step: 0.07 → 0.13 → 0.29 → 0.54 µg × kg⁻¹ × min⁻¹

3. A bolus dose of acetated Ringer's 15 mL × kg⁻¹ at a rate of 750 mL × h⁻¹

MAP

 > 100 mm Hg

If ongoing norepinephrine infusion, decrease rate one step: 0.54 → 0.29 → 0.13 → 0.07 µg × kg⁻¹ × min⁻¹