Difference between revisions of "Initial mechanical ventilation settings"

(See Also)
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[[Category:Critical Care]]  
 
[[Category:Critical Care]]  
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[[Category:Pulm]]
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== Lung Injury Strategy ==
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=== Background ===
 +
*Ok for all pts except for obstructed
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=== Settings ===
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*1. Mode
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**Assist control Volume
 +
 +
*2. Tidal Volume (lung protection)
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**Start 6-8cc/kg ideal body wt
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***Titrate down if peak pressure >30
 +
 +
*3. Inspiratory Flow Rate (comfort)
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**More comfortable if higher rather than lower
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**Start at 60-80 LPM
 +
 +
*4. Respiratory Rate (CO2)
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**Avg pt on ventilator requires 120mL/kg/min for eucapnia
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**Start 16-18 breaths/min
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**Maintain pH = 7.30-7.45
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*5. FiO2/PEEP (O2)
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**Move in tandem to achieve:
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***SpO2 BETWEEN 88-95%
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***PaO2 BETWEEN 55-80
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{| class="wikitable"
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|-
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| FiO2
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| 0.3
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| 0.4
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| 0.4
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| 0.5
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| 0.5
 +
| 0.6
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| 0.7
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| 0.7
 +
| 0.7
 +
| 0.8
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| 0.9
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| 0.9
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| 0.9
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| 1.0
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| 1.0
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| 1.0
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|-
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| PEEP
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| 5
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| 5
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| 8
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| 8
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| 10
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| 10
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| 10
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| 12
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| 14
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| 14
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| 14
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| 16
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| 18
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| 20
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| 22
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| 24
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|}
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 +
==Obstruction Strategy==
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===Background===
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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==
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*[[Ventilation (Main)]]
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*[[Ventilation (Settings)]]
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*[[Ventilation (Weaning)]]
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*[[Ventilation (Non-Invasive)]]
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*[[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

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
  • 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

See Also

Source

EMCrit Vent Lecture