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Initial setting: minute volume
Initial setting: normal tidal volume (the tidal volume is the volume of air that is inhaled or exhaled in a single such breath.)
10-15ml/kg body weight (less used with h/o COPD or restrictive lung disease)
Initial setting: rate
varies according to flow rate & what mode is being used
Initial setting: Sensitivity (the amount of inspired effort needed to intiate a breath)
-1 to -2 cm H2O
Initial setting: flow rate
40-80 L/min (COPD needs faster flow rate)
Initial setting: PEEP (positive end expiratory pressure)
5+ to 10+
Pt. has sleep apnea, what ventilator mode or NPPV would you want to put this pt on?
what are some diseases that would qualify patient to have NPPV?
- *HF induced Pulmonary edema
- *Sleep apnea
- *Neuromuscular (ALS)
- *Musculoskeletal disorders (muscular dystrophy)
Pt. has lung injury and chronic bronchitis, h/o asthma.
Basically pt has no breathing capacity
Pt. needs high flow rates to open lung compartments
Unnecessary airway pressure should be avoided
Which vent mode should we put patient on?
Pressure regulated volume control
In this mode everything is preset. Inspiratory pressure is delivered at the lowest pressure possible to deliver the full TV/minute volume
Pt. has some but not enough breathing capacity
Pt.'s ready to be weaned and do not require full ventilation
Although pt needs breath by breath variations in inspiratory pressure
Which vent mode should we put pt on?
this mode initiates every breath. similar to PRVC but no preset TV, flow, rate. Therefore we cannot assess every breath & patient's volumes
Pt. has no breathing capacity
Pt. has a leakage in the endotracheal tube
Pt. needs a high initial flow rate to open up closed lung compartments
Pt. has a lung injury
Pressure control ventilation
this mode is similar to A/C or SIMV but pressure controlled not volume controlled
Pt. is paralytics and we do not expect to wean him anytime soon.
What mode should he be on?
This mode has preset rate and tidal volume. ventilator takes over and delivers preset tidal volume
This mode is for patient who has some but not sufficient breathing capacity. It's usually used during weaning. Pt's post-operative
Synchronous intermittent mandatory ventilation
PIM- pressure triggered. tidal volume depends on pt's effort
VIM- if pt does not initiate a breath in 60 sec, ventilator will
Pt has intact respiratory drive
Pt's with adequate respiratory rates but cannot achieve adequate minute ventilation
We're weaning off pt
Pt needs additional monitoring
What mode should pt be on?
Usually used w/ SIMV
What's the first move towards weaning?
Lowering the FiO2
What would you like to do?
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