Initial mechanical ventilation settings

Initial

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

• Ventilation (Main)
• Ventilation (Weaning)
• Ventilation (Non-Invasive)
• Ventilation (Management)

Source

2/8/06 DONALDSON (adapted from emedicine, Lampe)