Transcript of HOW TO PICK INITIAL SETTINGS FOR A MULTIPLE CHOICE TEST Mechanical Ventilation.
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- HOW TO PICK INITIAL SETTINGS FOR A MULTIPLE CHOICE TEST
Mechanical Ventilation
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- Key words Disease Height and/or weight ABG Age Gender
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- Answer Components Mode Vt RR FiO2 PEEP
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- Tidal Volume 8-10 ml/kg normal 6-8 ml/kg ARDS 4-8 ml/kg Asthma
Determine IBW based on given height Or use weight given Find the
range
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- RR and Minute Ventilation RR x Vt determine minute ventilation
After determining the Vt choose a RR that will create the MV you
want 5-10 lpm normal range 7-8 for average patient Low end for COPD
High end for CHI
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- Mode Either A/C or SIMV for full control SIMV for COPD and
Asthma PCV in either A/C or SIMV for ARDS
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- Example patient You have a 48 year old male with pneumonia who
has developed sepsis. He is currently on a NRB mask with a RR of 25
and shallow breathing. His ABGs are pH 7.28, PaCO2 58, HCO3 26, and
PaO2 63, SpO2 91%. Which of the following initial vent settings
would be appropriate?
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- Example patient A) Assist Control, RR 10, Vt 600ml, FiO2 1.0,
PEEP 5 B) SIMV, RR 14, Vt 700ml, FiO2 0.5, PEEP 5 C) Assist
Control, RR 14, Vt 600ml, FiO2 0.5, Peep 10 D) SIMV, RR 12, Vt
650ml, FiO2 1.0, PEEP 5
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- Example patient You have a 48 year old, 58 male with pneumonia
who has developed sepsis. He is currently on a NRB mask with a RR
of 25 and shallow breathing. His ABGs are pH 7.28, PaCO2 58, HCO3
26, and PaO2 63, SpO2 91%. Which of the following initial vent
settings would be appropriate?
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- Example patient You have a 48 year old, 58 male with pneumonia
who has developed sepsis. He is currently on a NRB mask with a RR
of 25 and shallow breathing. His ABGs are pH 7.28, PaCO2 58, HCO3
26, and PaO2 63, SpO2 91%. Which of the following initial vent
settings would be appropriate?
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- Example patient You have a 48 year old, 58 male with pneumonia
who has developed sepsis. He is currently on a NRB mask with a RR
of 25 and shallow breathing. His ABGs are pH 7.28, PaCO2 58, HCO3
26, and PaO2 63, SpO2 91%. Which of the following initial vent
settings would be appropriate?
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- IBW Male IBW 106 + [6 x (height in inches-60)] 106 + [6 x (68
60)] 106 + [6 x 8] 106 + 48 154 pounds 2.2 = 70 kg
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- Easier IBW [(Height in inches 60) x 6] + 106 [(68 60) x 6] +
106 (8 x 6) = 106 48 + 106 154 lbs 2.2 = 70kg
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- Tidal Volume 70 kg IBW Use normal range for pneumonia 8-10ml/kg
70 x 8 = 560ml 70 x 10 = 700ml Tidal volume should be between
560-700ml
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- example Once you have determined Vt range you need to check
your options A) Assist Control, RR 10, Vt 800ml, FiO2 1.0, PEEP 5
B) SIMV, RR 14, Vt 500ml, FiO2 0.5, PEEP 5 C) Assist Control, RR
14, Vt 600ml, FiO2 0.5, Peep 10 D) SIMV, RR 12, Vt 650ml, FiO2 1.0,
PEEP 5
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- Find the right Vt A) Assist Control, RR 10, Vt 800ml, FiO2 1.0,
PEEP 5 B) SIMV, RR 14, Vt 500ml, FiO2 0.5, PEEP 5 C) Assist
Control, RR 14, Vt 600ml, FiO2 0.5, Peep 10 D) SIMV, RR 12, Vt
650ml, FiO2 1.0, PEEP 5 Both A and B can be eliminated due to the
Vt being out of range That leaves C and D
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- Minute ventilation C) Assist Control, RR 14, Vt 600ml, FiO2
0.5, Peep 10 D) SIMV, RR 12, Vt 650ml, FiO2 1.0, PEEP 5 Minute
ventilation for C is 8.4L Minute ventilation for D is 7.8L Because
both C and D meet the Vt range and the Minute Ventilation range it
is time to look at FiO2
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- FiO2 C) Assist Control, RR 14, Vt 600ml, FiO2 0.5, Peep 10 D)
SIMV, RR 12, Vt 650ml, FiO2 1.0, PEEP 5 The patient is already on
an FiO2 of 1.0 That makes D the best choice to maintain the FiO2 of
1.0 It is also not a good choice to start with a PEEP above 5, such
as in C, unless the patient was on more than 5 before
intubating
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- Mode Assist Control and SIMV are both acceptable for a
pneumonia patient as long as they are giving a full minute
ventilation