Initial mechanical ventilation settings

Initial

• FiO2 100% and ween down
• Rate 8-12/min
  • consider 5-6 for asthma w/ permissive hypercapnea
• Mode
  • A/C = defalt (most)
  • 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)
• PEEP 0-5 mmH20
• TV 5-8 cc/kg (eg. 500-600cc)
  • (adjust to plateau pressure <35 cmH20)
• I/E 1:3
• 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

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

CO2

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

pH

to increase pH 0.01 --> decrease pCO2 by 1

MISC (normally already set)

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

See Also

Mechanical Ventilation Pages

• Noninvasive ventilation
• Intubation
  • Intubation (peds)
• Mechanical ventilation (main)
  • Ventilation modes
  • Initial mechanical ventilation settings
    • Initial mechanical ventilation settings (peds)
  • Adjusting mechanical ventilation settings
    • Deterioration after intubation
    • Lung recruitment maneuver
    • Ventilator high pressures
    • Ventilator associated lung injury
  • Weaning mechanical ventilation
    • Extubation
• Miscellaneous
  • ARDS and EBQ:ARDSnet
  • Airway pressure release ventilation
  • Ideal Body Weight Estimation