Adult Patients ≥ 40 kg.
Assessment at Triage:
• Respiratory Rate
• SpO2
• FiO2 (nasal cannula 0.04/liter
added to 0.20)
• Check vitals (BP, temperature)
Ensure patient has patent IV access.
Prepare for intubation using sedation. Verify
patient wishes and code status.
Make decision to intubate or palliate.
• Titrate oxygen for SpO2 ≥ 90%.
• Initiate sedation for score of -1 to -2.
ROX score 4-6: Continue therapy.
ROX score > 6: Consider weaning PIP
gradually.
Continue proning as tolerated.
At 2-hour mark:
Repeat ABG, ROX score,
HACOR score, and RASS score.
Notify MD immediately as patient may need intubation.
Initiate HFNC at 100% or
YES Initiate GO2VENT at:
ROX score at triage
• Adjust pressure knob to 25-30 cm-H2O.
≤4
• 40 LPM at 100% FiO2 in assist setting.
• Maintain RASS between 0 and 1.
NO Perform ABG.
Titrate oxygen for SpO2 > 88%.
Maintain RASS between 0 and 1.
ROX score 4-6: Initiate GO2VENT.
• 15 LPM at 50% FiO2
At 1-hour mark: • Adjust pressure knob to 20-25 cm-H2O.
YES ROX < 4 • Place PEEP valve in line. Continue only as tolerated.
and/or pH ≤ 7.45 ROX score > 6: Initiate high flow nasal cannula.
and/or HACOR > 5 • Maintain SpO2 ≥ 88%.
NO
•If ROX score improves, maintain current therapy.
•If ROX score and HACOR score are unchanged,
increase PIP to 30 cm-H2O and increase PEEP.
•If HACOR score improves, maintain current therapy.
•If pH is 7.40-7.45, maintain current therapy.
ROX < 4
and/or NO •If pH is > 7.45, increase PIP to 30 cm-H2O and
increase PEEP.
pH ≤ 7.40
Maintain RASS between 0 and 1.
and/or After each hour, repeat Step 8.
HACOR > 5
YES Notify physician.
Prepare for chemically assisted intubation.
Optimize oxygen delivery to keep SpO2 > 90%.
Verify patient wishes: Intubation vs. palliate.