Initial mechanical ventilation settings
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
These settings are based on a lung protective strategy[1]
- 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
- Inspiratory Flow Rate (comfort)
- More comfortable if higher rather than lower
- Start at 60-80 LPM
- Respiratory Rate (titrate for ventilation)
- Avg pt 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
- 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[2]
- If >30 go down on rate
Making Setting Changes
O2
- PaO2 - ween to O2 >90% and PaO2 >60 mmHg)
- FiO2 - ween to < 50% if possisble while maintaining adequate PaO2
- PEEP - refer to ARDsnet protocol to avoid barotrauma
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
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.