Ventilator Management

Ventilator Strategies

INJURY PREVENTION strategy
(Default approach)
AC
6-8 cc/kg tidal volume
Insp Flow Rate 60-80 lpm
RR 14-18
FiO2 100% initially, PEEP 5 or less
Get ABG in 5 mins.
Then FiO2 30% and titrate to PaO2 60-80 or spO2% 88-95

Typical FiO2 / PEEP Chart

FiO2 0.3 0.4 0.4 0.5 0.6 0.7 0.7 0.7 0.8 0.9
PEEP 5 5 8 8 10 10 12 14 14 16-18

(up to 100% and PEEP 25)
(Or use the ARDS Net chart).

Using increased PEEP is …
Good: Will increase V/Q matching, and decrease trauma and shunting
Bad: May decrease preload / BP

Ignore peak pressures.
Check plateau pressures (at inspiratory hold). If plateau > 30 cm H2O, dial down tidal volume, as low as 4 cc/kg

OBSTRUCTIVE strategy
(For asthma / COPD)
AC
6-8 cc/kg tidal volume
Insp Flow Rate 80-100 lpm
RR 10 initially. Aim for I:E ratio of 1:4 or 1:5 and titrate rate to achieve
FiO2 40% initially, "ZEEP" for PEEP (0-5)

Inline nebs Q1 hour.
Permissive hypercapnia. May need lots of sedation / narcotics, possibly even paralysis. If pH < 7.1 as result may need bicarb gtt.

Vent Patient Deteriorates?

vent pt deteriorates.jpg
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