Initial mechanical ventilation settings
Revision as of 03:45, 13 November 2015 by Neil.m.young (talk | contribs) (ardsnet used predicted not ideal BW)
Initial
- FiO2 100% (1.0) and ween down
- Rate 8-12/min
- consider 5-6 for asthma w/ permissive hypercapnea
- Mode
- 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% |
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
- Start 6-8cc/kg predicted body wt
- 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
- Move in tandem to achieve:
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
- Noninvasive ventilation
- Intubation
- Mechanical ventilation (main)
- Miscellaneous