These 10 strategies are broad mechanical/physiological categories, not an exhaustive diagnosis list. Most other ICU conditions map onto whichever pattern dominates the lung mechanics — pick the category, not the diagnosis label.
Condition
Pneumonia (mild/localized)→ Normal Lung
Pneumonia (severe, P/F <300)→ ARDS
COVID‑19 respiratory failure→ ARDS
Pulmonary fibrosis / ILD→ Restrictive
Kyphoscoliosis / chest wall deformity→ Restrictive
Large pleural effusion / flail chest→ Restrictive
Guillain‑Barré, myasthenia gravis, ALS→ Neuromuscular
Critical illness myopathy→ Neuromuscular
Stroke, TBI, status epilepticus→ Neuro / Raised ICP
Post‑neurosurgery→ Neuro / Raised ICP
Condition
DKA, lactic acidosis, salicylate toxicity→ Metabolic Acidosis
Renal failure acidosis→ Metabolic Acidosis
CHF, cardiogenic pulmonary edema→ Cardiac / Pulm. Edema
Post‑cardiac surgery→ Cardiac / Pulm. Edema
Bronchiectasis, chronic bronchitis→ COPD / Obstructive
Anaphylaxis with bronchospasm→ Severe Asthma
Routine elective post‑op→ Normal Lung / Post‑op
Uncomplicated intubation→ Normal Lung / Post‑op
BMI > 35, any lung condition→ Obesity
Overlap cases the tool can't auto-resolve — pick whichever mechanism is more immediately dangerous (usually oxygenation/barotrauma risk) and adjust manually:
-
COPD + superimposed ARDS (pneumonia/aspiration) — obstructive and hypoxemic at once.
- Keep mode: Pressure Control (ARDS default) — it also tolerates COPD's high airway resistance reasonably well.
- VT: use the ARDS target — 6 mL/kg PBW (4–8 range) — not the COPD default of 6–8 mL/kg.
- RR: do not auto-titrate up for acidosis the way plain ARDS logic would; keep RR lower and accept permissive hypercapnia (pH ≥7.20) to limit auto‑PEEP.
- I:E / flow: borrow from the COPD strategy — extend expiratory time (I:E 1:3 or longer) and raise inspiratory flow, even though standard ARDS uses I:E 1:2.
- PEEP: start from the ARDSNet table for oxygenation, but trend an expiratory hold (auto‑PEEP check) — extrinsic PEEP should not simply stack on top of undetected intrinsic PEEP.
-
Obesity + ARDS — combine PBW‑based low Vt with the ARDSNet PEEP table; expect higher PEEP needs than either alone predicts.
- Keep mode: Pressure Control (ARDS default).
- VT: strictly PBW‑based (not actual body weight) — 6 mL/kg PBW target, 4–8 mL/kg range, same as plain ARDS.
- PEEP: start from the ARDSNet table for the current FiO₂, but expect to need 2–4 cmH₂O above the table value — elevated abdominal/chest-wall pressure reduces the PEEP that's actually reaching the alveoli. Verify against plateau pressure (accept up to ~35 cmH₂O in morbid obesity, since transpulmonary pressure runs lower than plateau suggests) and driving pressure.
- Positioning: reverse Trendelenburg / head-of-bed elevation to offload the diaphragm — this is not something the calculator can set.
-
Neuromuscular weakness + aspiration pneumonia — weaning‑focused SIMV/PSV logic conflicts with acute lung‑protective needs.
- Keep mode: stay on an acute mandatory mode (PC or VC‑AC) — do NOT move to the neuromuscular strategy's weaning-oriented SIMV/PSV until the acute lung injury resolves.
- VT: switch to the ARDS target — 6 mL/kg PBW (4–8 range) — instead of the neuromuscular strategy's normal 6–8 mL/kg, since aspiration can produce a genuine ARDS pattern.
- PEEP/FiO₂: use the ARDSNet table, titrated to oxygenation, same as plain ARDS.
- RR: titrate from the actual ABG (as ARDS does), not the neuromuscular strategy's fixed weaning rate.
- Transition point: once oxygenation normalizes (P/F ≥300, PEEP/FiO₂ needs falling), switch back to the neuromuscular weaning path — SIMV → PSV, monitored by NIF/VC.
This mapping is a general reference, not a diagnostic tool — clinical judgment and full patient context always take priority over category assignment.