Vent Settings & Lessons

Course overview

Objectives Identify key vent settings Describe how these settings may be adjusted to manage a patient in respiratory distress or failure appropriately Explain how the underlying cause of respiratory distress affects vent settings and patient management Describe how positive pressure ventilation may affect a patients underlying condition Content Summary Steve Dan and Holly introduce their guest speaker Carrie a respiratory therapist paramedic from Washington Carrie discusses the endotracheal tube and the importance of having a correctly sized and placed tube Carrie highlights how critical it is to understand the disease processes that resulted in the patient being intubated Ventilation and oxygenation issues are reviewed along with the importance of PEEP in intubated patients Carrie talks about PEEP in intubated patients with asthma or COPD as well as variations in tidal volume settings for various disease processes The group discusses minute volume and how a patients minute volume is calculated on the ventilator Carrie discusses her process of titrating ventilator settings to meet a CO2 goal Do no harm is reviewed in relation to mechanical ventilation and consequences of a patient working against the ventilator are discussed Assist control AC and synchronous intermittent mandatory ventilation SIMV modes are compared Carrie details what modes she prefers for specific patient presentations and disease processes The group discusses volume and pressure control and reviews a trauma scenario where the patient is intubated Peak inspiratory pressure and peak alveolar pressure are reviewed along with what abnormal values can indicate The importance of driving pressure is highlighted The PF ratio is discussed along with the importance of weaning patients off of 100 percent FiO2 The group ends with discussing appropriate IE ratios in obstructive patients Flow rate in both volume and pressure control are reviewed as well as the effect of flow rate on a patient in both volume and pressure control settings Another scenario is discussed a COPD patient that has been intubated Carrie walks through troubleshooting tactics for ventilators and potential fixes for common issues with mechanical ventilators Learning Points Always check size and depth of the ET tube because this will affect ventilator effectiveness ET tube depth formula pts height in inches divided by 4 plus 4 for a patient greater than 5 feet tall An ET tube placed too deep can affect ventilation and oxygenation particularly in smaller patients Patients intubated for non respiratory disease processes should be relatively easy to ventilate and typically require less advanced ventilator settings Ventilation issues are fixed with changes in tidal volume or respiratory rate Oxygenation issues are fixed with FiO2 and PEEP Minimum PEEP setting is 5 to allow the lungs to remain open and increase oxygenation Obese patients may need a PEEP of 10 Six to eight milliliters per kilogram ideal body weight is a typical tidal volume setting ARDS patients may require smaller tidal volumes approximately four to five milliliters per kilogram Minute volume equals tidal volume times respiratory rate A higher exhaled tidal volume may mean that the patient is working against the ventilator Metabolic acidosis patients require high rates of ventilation Obstructive patients require low rates of ventilation and adequate time for expiration There is no difference between AC and SIMV modes in chemically sedated patients Peak inspiratory pressure is directly proportional to resistance in the upper airway Peak alveolar pressure is directly proportional to compliance in the lower airway Driving pressure in pressure control setting is the difference between PEEP and PIP Driving pressure in volume control setting is the difference between peak alveolar pressure and PEEP Driving pressure should be less than 14 PF ratio for ARDS 300 equals mild lung injury 200 equals moderate lung injury 100 equals severe lung