3.7 Conclusion
At the end of this chapter, you should feel comfortable choosing initial settings for control modes of ventilation for adult patients. These initial settings will be reevaluated with an arterial blood gas to assess the adequacy of their ventilation for their CO2 and O2 levels. Changes are usually made once ABGs are obtained. We will discuss ABGs and making changes in later Chapters, but remember, you need to start somewhere! Clinicians often choose initial settings by employing educated guesses regarding their patient’s ventilatory needs based on how they presented prior to intubation, and what is expected from each patient physiologically.
In summary, these are the initial settings you have learned in this chapter. Keep in mind these values are general guidelines and can be adjusted to more appropriate levels for individual patients:
| Initial Setting | Volume Control | Pressure Control | Rationale |
|---|---|---|---|
| FiO2 | [latex]1.0[/latex] or [latex]0.5[/latex] | [latex]1.0[/latex] or [latex]0.5[/latex] | Based on oxygenation status and then wean to [latex]\text{SpO}_2>92\%[/latex] |
| PEEP | [latex]5\text{ - }8\text{ cmH}_2\text{O}[/latex] | [latex]5\text{ - }8\text{ cmH}_2\text{O}[/latex] | Based on lung physiology and whether a patient would benefit from recruitment/extra push for oxygen |
| RR | [latex]14\text{ - }20\text{ bpm}[/latex] | [latex]14\text{ - }20\text{ bpm}[/latex] | Choose a number based on whether the patient was breathing slower or faster before |
| Tidal Volume | [latex]8\text{ mL/Kg}[/latex] | N/A | Use your patient’s height and weight to calculate their IBW and find the safe range [latex](6\text{ - }8\text{ mL/Kg})[/latex] |
| Pressure Control | N/A | [latex]15\text{ cmH}_2\text{O}[/latex] then titrate up or down to get a [latex]V_T[/latex] of [latex]8\text{ ml/Kg}[/latex] | Use your patient’s height and weight to calculate their IBW and find the safe range [latex](6\text{ - }8\text{ mL/Kg})[/latex] |
| Inspiratory Flow | [latex]65\text{ Lpm}[/latex] | N/A | Can increase slightly if the patient is pulling faster than the ventilator (up to [latex]80\text{ Lpm}[/latex]) |
| Inspiratory Time | N/A | [latex]1.0\text{ second}[/latex] | Can shorten slightly if the patient is trying to exhale (down to [latex]0.8\text{ seconds}[/latex]) |
“Chapter 5 Conclusion” from Basic Principles of Mechanical Ventilation by Sault College is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.
