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Rules for Mechanical Ventilation & Initial Settings
Terms in this set (50)
Remember when looking at values to assess the ventilation before oxygenation then ventilatory mechanics.
How to determine initial tidal volume
50 kg + 2 x any inches over 5 ft. Add together and then calculate. Tidal Volume is 5 - 10 ml/Kg
If shorter than 5 Ft. Subtract instead of add then multiply
When Answering a question on an exam. It does NOT matter about mode. Do NOT use mode to decide your choice of ventilatory support.
What is the Ranges of Respiratory Rate according to the NBRC?
10 - 20 BPM for mechanical ventilation
If patient was on CPAP prior to intubation, what do you use for FIO2 setting?
Use the FIO2 from the CPAP settings.
If a patient is NOT on CPAP prior to intubation what FIO2 do you start patients out at?
The lowest of 40 - 60%. Most likely 40%
Do you ever increases beyond 60%?
No...once you reach 60, you start to increase PEEP for the patient
For Patients with ARDS and Status Asthmaticus what is the recommended Tidal Volume range
4 - 8 ml/Kg - Usually go with 8
If you are in Pressure Control what do you use for your Tidal Volume Setting?
If you are switching from Volume Control, use Pplat for Inspiratory Pressure
Or to achieve target Tidal Volume Use less than or equal to 30 to 35 mmHG
What Respiratory Rate do you use for mechanical ventilation
10 to 20 BPM Remember changes are in 4 - 6 BPM
What FIO2 do you use for mechanical ventilation
40 - 60% or previous setting used before intubation. Remember changes are in 5 - 10 % increments.
What PEEP setting do you use for mechanical ventilation
2 - 6 cmH20
Remember though - Changes are in 2 - 6 cmH20
What are the three steps to normalize a PaCo2 (Hypoventilation, Hypercapnia, decreased minute ventilation, etc...)
1. If they have dead space remove it
2. Increase the Tidal Volume or Increase the IP
3. Increase the RR or Increase the TI
What does adding deadspace do for a patient?
Creates rebreathing of PaCO2. So if akolotic do this.
What are the steps to normalize Low PaCO2 or respiratory alkolosis (hyperventilation, hypocapnia, increased minute ventilation)
1. Is the patient Hypoxemia (low PaO2)----If yes ---Address oxygenation...is it caused by pain, fever (which would shift the curve)...do they need sedative are they agitated or need pain med? To correct Hypoxemia give them FIO2 or Increase PEEP (see rules below)
2. Decrease the RR
3. Decrease the Tidal Volume or Decreased the IP...watch out for Atelectasis
DEADSPACE or Decrease the TI
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