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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