Difference between revisions of "Initial mechanical ventilation settings"

(Table)
(Initial)
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##SIMV = with obstructive airway disease and an intact respiratory effort (e.g. some COPD, asthma)  
 
##SIMV = with obstructive airway disease and an intact respiratory effort (e.g. some COPD, asthma)  
 
##PC = with intact respiratory effort and non-severe respiratory failure (prefered in chronic vent)  
 
##PC = with intact respiratory effort and non-severe respiratory failure (prefered in chronic vent)  
#Peep 0-5 mmH20  
+
#PEEP 0-5 mmH20  
 
#TV 5-8 cc/kg (eg. 500-600cc)  
 
#TV 5-8 cc/kg (eg. 500-600cc)  
 
##(adjust to plateau pressure <35 cmH20)  
 
##(adjust to plateau pressure <35 cmH20)  

Revision as of 04:51, 29 September 2013

Initial

  1. FiO2 100% and ween down
  2. Rate 8-12/min
    1. consider 5-6 for asthma w/ permissive hypercapnea
  3. Mode
    1. A/C = defalt (most)
    2. SIMV = with obstructive airway disease and an intact respiratory effort (e.g. some COPD, asthma)
    3. PC = with intact respiratory effort and non-severe respiratory failure (prefered in chronic vent)
  4. PEEP 0-5 mmH20
  5. TV 5-8 cc/kg (eg. 500-600cc)
    1. (adjust to plateau pressure <35 cmH20)
  6. I/E 1:3
  7. PS (pressure support) 5-8cm to overcome ET

Table

Disease TV^ RR I:E PEEP
Nl lung 8 10-12 1:2 4
Obstruct 6 5-8 1:4 4
ARDS 6 12-20 1:2 2-15
Hypovol 8 10-12 1:2 0-4

^cc/kg

^^FiO2 always = 1.0

See also Ventilation (Strategies)

Changes

O2

  1. PaO2 (ween to SaO2 >90% & PaO2 >60)
  2. FiO2 (ween to <0.5 if poss)
  3. PEEP (see ARDS schedule; if >10, should have art line)
    1. (rule of 7s: decrease 1 FiO2 = 7 pO2)

CO2

  1. PCO2
    1. TV
    2. Rate
  2. (VE-1 x pCO2-1 = VE-2 x pCO2-2)
    1. VE = minute ventilation (RR x TV)

pH

to increase pH 0.01 --> decrease pCO2 by 1

MISC (normally already set)

  1. Inspiratory flow rate = 60L/min (100L/min with asthma)
  2. Sensitivity = 1-2 cmH2O

See Also

Source

2/8/06 DONALDSON (adapted from emedicine, Lampe)