Initial mechanical ventilation settings: Difference between revisions
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{{Initial ventilation settings table}} | {{Initial ventilation settings table}} | ||
== | ==Traditional== | ||
*FiO2 100% (1.0) and ween down | *FiO2 100% (1.0) and ween down | ||
*Rate 8-12/min | *Rate 8-12/min | ||
Revision as of 16:14, 22 July 2019
Overview
Initial ventilation settings
| Disease | Tidal Volume (mL/kg^) | Respiratory Rate | I:E | PEEP | FiO2 |
| Traditional | 8 | 10-12 | 1:2 | 5 | 100% |
| Lung Protective (e.g. ARDS) | 6 | 12-20 | 1:2 | 2-15 | 100% |
| Obstructive (e.g. bronchoconstriction) | 6 | 5-8 | 1:4 | 0-5 | 100% |
| Hypovolemic | 8 | 10-12 | 1:2 | 0-5 | 100% |
Traditional
- FiO2 100% (1.0) and ween down
- Rate 8-12/min
- consider 5-6 for asthma with permissive hypercapnea
- Mode
- PEEP 0-5 mmH20
- Tidal volume: 5-8 cc/kg (eg. 500-600cc)
- (adjust to plateau pressure <35 cmH20)
- I/E 1:2
- Pressure support: 5-8cm to overcome endotracheal tube
Lung Protective Strategy[1]
Background
- To prevent or treat patients with ARDS or other lung injury
- Indicated for all intubated patients who do not have obstructive lung disease (COPD, asthma)
- Based on ARDSnet trial with demonstrated mortality benefit
Settings
- Mode
- Assist control Volume
- Tidal Volume (lung protection)
- Start 6-8cc/kg predicted body wt
- Predicted body weight is used because a persons lung parenchyma does not increase in size as the person gains more weight.
- Titrate down if peak pressure >30 mmHg
- Start 6-8cc/kg predicted body wt
- Inspiratory Flow Rate (comfort)
- More comfortable if higher rather than lower
- Start at 60-80 LPM
- Respiratory Rate (titrate for ventilation)
- Avg patient on ventilator requires 120mL/kg/min for eucapnia
- Start 16-18 breaths/min
- Maintain pH = 7.30-7.45
- FiO2/PEEP (titrate for oxygenation)
- 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
- Mode
- Assist Control Volume
- Tidal Volume
- Vt = 6-8 cc/kg of Ideal Body Weight
- Ideal Body Weight used because lung parenchyma does not increase in size as the person gains more weight
- Vt = 6-8 cc/kg of Ideal Body Weight
- Inspiratory Flow Rate
- Set at 80-100 LPM to allow more expiration time
- FiO2/PEEP
- Titrate FiO2 to desired SpO2
- Set PEEP 0-4
- 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[2]
- If >30 go down on rate
Hypovolemic
- Consider reducing PEEP to maintain adequate preload and prevent/minimize hypotension
Miscellaneous
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
- Ideal Body Weight Estimation
References
- ↑ The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301-1308.
- ↑ 20. Oddo M, Feihl F, Schaller MD, Perret C. Management of mechanical ventilation in acute severe asthma: practical aspects. Intensive Care Med. 2006; 32(4):501-510.