Initial mechanical ventilation settings

Revision as of 03:45, 13 November 2015 by Neil.m.young (talk | contribs) (ardsnet used predicted not ideal BW)
The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.

Initial

  • FiO2 100% (1.0) and ween down
  • Rate 8-12/min
    • consider 5-6 for asthma w/ permissive hypercapnea
  • Mode
    • A/C = default (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 1:2
  • PS (pressure support) 5-8cm to overcome endotracheal tube

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%

^Ideal body weight

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 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
  • 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 predicted 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

Making Setting Changes

O2

  • PaO2 (ween to SaO2 >90% and PaO2 >60)
  • FiO2 (ween to <0.5 if poss)
  • PEEP (see ARDS schedule; if >10, should have arterial 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

References