Initial mechanical ventilation settings: Difference between revisions
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[[Category:Critical Care]] | [[Category:Critical Care]] | ||
[[Category:Pulm]] | |||
== 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 | |||
{| class="wikitable" | |||
|- | |||
| 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 | |||
==See Also== | |||
*[[Ventilation (Main)]] | |||
*[[Ventilation (Settings)]] | |||
*[[Ventilation (Weaning)]] | |||
*[[Ventilation (Non-Invasive)]] | |||
*[[Ventilator Desaturation]] | |||
==Source== | |||
EMCrit Vent Lecture | |||
[[Category:Critical Care]] | |||
[[Category:Pulm]] | [[Category:Pulm]] |
Revision as of 11:14, 26 August 2015
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
- Mechanical ventilation (main)
- Miscellaneous
Source
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
- Start 6-8cc/kg ideal body wt
- 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
- Move in tandem to achieve:
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
See Also
- Ventilation (Main)
- Ventilation (Settings)
- Ventilation (Weaning)
- Ventilation (Non-Invasive)
- Ventilator Desaturation
Source
EMCrit Vent Lecture