Initial Ventilator Settings

Written on 10/10/2024
jombuatapp

Summary of Initial Ventilator Settings

Parameter Initial Setting
Mode SIMV or Assist-Control (Volume or Pressure Control)
Tidal Volume 6–8 mL/kg IBW (4–6 mL/kg in ARDS)
Respiratory Rate 12–16 breaths per minute (lower in obstructive diseases)
FiO₂ Start at 100%, titrate to maintain SpO₂ 92–96%
PEEP 5 cm H₂O (adjust as needed)
I:E Ratio 1:2 (adjust in obstructive diseases)
Inspiratory Flow 60–80 L/min (higher in obstructive diseases)

 

Note: Always tailor ventilator settings to the individual patient's needs, underlying pathology, and response to therapy. Frequent reassessment and adjustment are essential.

 

1. Calculate the Patient's Ideal Body Weight (IBW)

Accurate tidal volume settings are based on the patient's Ideal Body Weight (IBW), not their actual weight, to minimize the risk of ventilator-induced lung injury.

 

2. Choose the Ventilator Mode

Select a mode that best suits the patient's respiratory needs.

 

A. Synchronized Intermittent Mandatory Ventilation (SIMV):

  • Delivers a set number of mandatory breaths synchronized with the patient’s own breathing efforts.
  • Allows spontaneous breaths between mandatory breaths with or without pressure support.

B. Assist-Control Ventilation (A/C):

  • Delivers a preset tidal volume or pressure with each initiated breath, whether by the patient or the ventilator.
  • Provides full ventilatory support, suitable for patients not initiating adequate spontaneous breaths.

 

Note: The choice between SIMV and A/C depends on the patient's respiratory drive and the desired level of support.

 

3. Initial Settings:

A. Volume-Controlled Ventilation

    i) Tidal Volume:

  • Set at 6–8 mL/kg of IBW to reduce the risk of barotrauma and volutrauma.
  • For patients with ARDS or lung injury, use lower tidal volumes (6 mL/kg IBW).

    ii) Respiratory Rate (RR):

  • Start with 12–16 breaths per minute.
  • Adjust based on arterial blood gases (ABGs) to achieve normocapnia.

    iii) FiO₂ (Fraction of Inspired Oxygen):

  • Begin with 100% FiO₂.
  • Titrate down to maintain SpO₂ between 92–96% to minimize oxygen toxicity.

    iv) PEEP (Positive End-Expiratory Pressure):

  • Start with 5 cm H₂O.
  • Adjust PEEP to improve oxygenation while avoiding hemodynamic compromise.

    v) Inspiratory Flow Rate:

  • Set between 60–80 L/min to meet the patient's inspiratory demands.

 

B. Pressure-Controlled Ventilation

    i) Inspiratory Pressure:

  • Adjust to achieve the desired tidal volume (monitor closely).
  • Begin with an inspiratory pressure of 15–25 cm H₂O above PEEP.

    ii) Inspiratory Time (I-Time):

  • Set to achieve an I:E ratio (Inspiratory) of 1:2 or 1:3.

    iii) Other Settings:

  • RR, FiO₂, and PEEP as per volume-controlled ventilation.

 

Note: Pressure-controlled modes are beneficial in patients with poor lung compliance to limit peak airway pressures.