Vent Settings & Supplemental O2

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General Vent Concepts
-oxygenation: PEEP, FiO2
-ventilation: TV, RR

-PEEP = alveolar recruitment (oxygenation)
-RR = time to exhale (ventilation)
-TV = 6-8mL/kg IBW (ideal body weight) — titrate to protect alveoli (baby lungs)

NIV
-IPAP/EPAP = 10/5
-EPAP = PEEP (recruitment/oxygenation)
-IPAP = pressure control (PC) over PEEP (PC minus PEEP = TV) – increasing IPAP (PC) without changing PEEP increases TV (ventilation)

 

Initial Vent Settings

Nonobstructive process:
-PEEP 5
-RR 16 or higher if metabolic acidosis…..MICU: after paralyze, initially ventilate at RR 25-30 to blow off acid accumulated during apneic period

Obstructive (asthma/COPD):
-ZEEP (zero or minimal PEEP/EPAP) with high IPAP (promote air movement for fatigued respiratory muscles)
-low RR (10)

ARDS (baby lung):
-400-450 mL males; 350-400 mL females (4-6 mL/kg IBW)

 

Post Intubation
-bring initial RR to 25-30 – to blow off CO2 accumulated during apneic period
-fentanyl drip, then assess for further need for sedation if tachycardic or diaphoretic (neuromuscular blockade only affects nicotinic/motor receptors)

Check for autoPEEP: hold “expiratory hold”
Check plateau pressure: hold “inspiratory hold”

 

FYI
-prior to intubation of severely acidotic pt, consider giving several bicarb pushes OR bagging pt during apneic period – to prevent pt from coding during apneic period from severe acidosis

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