Chapter 5 | Control Modes: Initial Ventilator Settings

Overview

We have discussed in detail control modes of ventilation and differentiated between volume and pressure control. In Chapter 4, we highlighted the settings that need to be set for control modes. In this chapter we will discuss how to approach choosing initial settings for a patient when you first initiate mechanical ventilation.

The scope of this book is adult ventilation. The settings discussed in this chapter are suggestions for adult populations only. Please refer to your specific policies and procedures or physician orders above these recommendations. If the patient is pediatric or neonatal, similar rules do apply, but they are not fully discussed in this book. Refer to your ordering physician or registered respiratory therapist.

In this chapter we will cover:

  • Commonly used initial settings in control modes
  • How to calculate Ideal Body Weight
  • How to calculate safe ranges for tidal volumes and flow
  • Suggested settings for ventilator alarms

Application

Once arterial blood gas (ABG) results come in, clinicians can make better informed decisions about ventilator settings, but you need to start somewhere! Clinicians choose initial settings by employing educated guesses regarding their patient’s ventilatory needs based on how they presented prior to intubation. This chapter will help you to make these educated guesses effectively, and use this information to choose appropriate ventilator settings. Even if you have ABGs to begin with, the information in this chapter is still essential to understanding how the patient’s presenting status impacts your decisions about ventilator settings.

Learning Objectives

At the end of this chapter, you will be able to:

  1. Identify which initial settings are mandatory in volume control and pressure control.
  2. Describe how patient status impacts decisions about ventilator settings.
  3. Explain why Ideal Body Weight and the safe range for tidal volumes became standard practice for ventilation decision-making.
  4. Calculate Ideal Body Weight for a patient.
  5. Calculate the safe range for tidal volumes for a patient.
  6. Choose recommended ventilator settings based on your mode and patient status.
  7. Set ventilator alarms effectively to ensure safe monitoring of the patient when not at bedside.

Key Terms

In this chapter, you will learn about all of the following key terms. These terms will be used throughout this book, so it is important to take the time to master them and practice your recall often.

  • recruiting
  • titrate
  • atelectasis
  • tachypnea
  • Arterial Blood Gas (ABG)
  • Ideal Body Weight (IBW)
  • Ventilator Induced Lung Injury (VILI)
  • Acute Respiratory Distress Syndrome (ARDS)
  • barotrauma
  • volutrauma
  • decelerating flow pattern

Whenever these terms are first introduced in this chapter, they are bolded. However, if you need additional information about a term than what is provided here, you can research it in The Free Dictionary: Medical Dictionary.

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Basic Principles of Mechanical Ventilation Copyright © 2022 by Sault College is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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