Difference between revisions of "Initial mechanical ventilation settings"

(Table)
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==Initial==
+
== 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 ==
+
#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 &lt;35 cmH20)
 +
#I/E 1:3
 +
#PS (pressure support) 5-8cm to overcome ET
 +
 
 +
===Table===
  
 
{| cellspacing="1" cellpadding="1" border="1" width="200"
 
{| cellspacing="1" cellpadding="1" border="1" width="200"
 
|-
 
|-
| '''Disease'''
+
| '''Disease'''  
| '''TV^'''
+
| '''TV^'''  
| '''RR'''
+
| '''RR'''  
| '''I:E'''
+
| '''I:E'''  
 
| '''PEEP'''
 
| '''PEEP'''
 
|-
 
|-
| Nl lung
+
| Nl lung  
| 8
+
| 8  
| 10-12
+
| 10-12  
| 1:2
+
| 1:2  
 
| 4
 
| 4
 
|-
 
|-
| Obstruct
+
| Obstruct  
| 6
+
| 6  
| 5-8
+
| 5-8  
| 1:4
+
| 1:4  
 
| 4
 
| 4
 
|-
 
|-
| ARDS
+
| ARDS  
| 6
+
| 6  
| 12-20
+
| 12-20  
| 1:2
+
| 1:2  
 
| 2-15
 
| 2-15
 
|-
 
|-
| Hypovol
+
| Hypovol  
| 8
+
| 8  
| 10-12
+
| 10-12  
| 1:2
+
| 1:2  
 
| 0-4
 
| 0-4
 
|}
 
|}
  
 +
<br>
  
 +
^cc/kg
  
^cc/kg
+
^^FiO2 always = 1.0
 +
 
 +
== Changes ==
 +
 
 +
=== O2 ===
  
^^FiO2 always = 1.0
+
#PaO2 (ween to SaO2 &gt;90% &amp; PaO2 &gt;60)
 +
#FiO2 (ween to &lt;0.5 if poss)
 +
#PEEP (see ARDS schedule; if &gt;10, should have art line)
 +
##(rule of 7s: decrease 1 FiO2 = 7 pO2)
  
==Changes==
+
=== CO2 ===
===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  
#PCO2
+
##TV  
##TV
+
##Rate  
##Rate
+
#(VE-1 x pCO2-1 = VE-2 x pCO2-2)  
#(VE-1 x pCO2-1 = VE-2 x pCO2-2)
 
 
##VE = minute ventilation (RR x TV)
 
##VE = minute ventilation (RR x TV)
  
===pH===
+
=== pH ===
to increase pH 0.01 --> decrease pCO2 by 1
 
  
==MISC (normally already set)==
+
to increase pH 0.01 --&gt; decrease pCO2 by 1
# Inspiratory flow rate = 60L/min (100L/min with asthma)
+
 
# Sensitivity = 1-2 cmH2O
+
== MISC (normally already set) ==
 +
 
 +
#Inspiratory flow rate = 60L/min (100L/min with asthma)  
 +
#Sensitivity = 1-2 cmH2O
 +
 
 +
== See Also ==
  
==See Also==
 
 
*[[Vent (General)]]  
 
*[[Vent (General)]]  
*[[Vent (Weaning)]]
+
*[[Vent (Weaning)]]  
 
*[[Ventilation (Non-Invasive)]]  
 
*[[Ventilation (Non-Invasive)]]  
 
*[[Ventilator Management]]
 
*[[Ventilator Management]]
  
==Source==
+
== Source ==
2/8/06 DONALDSON (adapted from emedicine, Lampe)  
+
 
 +
2/8/06 DONALDSON (adapted from emedicine, Lampe)  
  
[[Category:Airway/Resus]]
+
[[Category:Airway/Resus]] [[Category:Pulm]]
[[Category:Pulm]]
 

Revision as of 21:14, 22 July 2011

Initial

  1. FiO2 100% and ween down
  2. Rate 8-12/min (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) (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

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)