Ventilation (Strategies)

Lung Injury Strategy

Background

• Ok for all pts except for obstructed

Settings

• 1. Mode
  • Assist control Volume

• 2. Tidal Volume (lung protection)
  • Start 6-8cc/kg ideal body wt
    • Titrate down if peak pressure >30

• 3. Inspiratory Flow Rate (comfort)
  • More comfortable if higher rather than lower
  • Start at 60-80 LPM

• 4. Respiratory Rate (CO2)
  • Avg pt on ventilator requires 120mL/kg/min for eucapnia
  • Start 16-18 breaths/min
  • Maintain pH = 7.30-7.45

• 5. FiO2/PEEP (O2)
  • Move in tandem to achieve:
    • SpO2 BETWEEN 88-95%
    • PaO2 BETWEEN 55-80

FiO2	0.3	0.4	0.4	0.5	0.5	0.6	0.7	0.7	0.7	0.8	0.9	0.9	0.9	1.0	1.0	1.0
PEEP	5	5	8	8	10	10	10	12	14	14	14	16	18	20	22	24

Obstruction Strategy

Background

Goal = Adequate time for expiration

Settings

• 1. Mode
  • Assist Control Volume

• 2. Tidal Volume
  • Vt = 8 cc/kg ideal body wt

• 3. Inspiratory Flow Rate
  • Set at 80-100 LPM to allow more expiration time

• 4. FiO2/PEEP
  • Titrate FiO2 to desired SpO2
  • Set PEEP 0-4

• 5. Respiratory Rate
  • Set low - 10 BPM
  • Adjust for I:E 1:4 or 1:5
  • Permissive hypercapnia to avoid breath stacking
    • Ok as long as pH > 7.00-7.10
    • Maintain plateau pressure <30
      • If >30 go down on rate

Source

EMCrit Vent Lecture