Chapter 6: Intial Vent Settings Flashcards
Minute Ventilation (VE)
Men VE = 4 x body surface area
Women VE = 3.5 x body surface area
Increased minute ventilation by 10% for every degree Celsius over 37. Increase 20% for metabolic acidosis. Increase 50 to 100% if resting energy expenditure is equally increased
Decrease minute ventilation by 10% for every degree between 35°C - 37C
About 100ML/kg of ideal body weight
Respiratory Rate
(f) = VE / VT
Tidal Volume (VT)
Minimum of 6 mL per kilogram of ideal body weight (consider psi or lung recruitment maneuver and high peep)
Maximum of 8 mL per kilogram of ideal body weight (do not use sigh)
Keep Alveolar pressure under 30 cm H2O (assumes thoracic compliance is normal)
* special exceptions for patients being ventilated with ARDS (4-8ml/kg of IBW)*
Pressure support ventilations (PSV)
To overcome system resistance in the spontaneous mode (PSV or CPAP) or IMV mode.
Set target pressure to PIP - Pplateau. This is where Pplateau is measured in a volume breath
Or
Approximately 5-10 cmH20
The goal is to achieve an appropriate VT
Pressure control ventilation or PC-CMV
Set pressure to achieve appropriate VT
Set inspiratory percentage to achieve an inspiratory expiratory i:e ratio of greater or equal to 1:2
Ideal body weight for women (lbs)
105+5(height in inch - 60)
= lbs …. then convert to KG
Ideal body weight for men (lbs)
106+6(height in inch - 60)
= lbs …. then convert to KG
Total cycle time (TCT)
TCT = Ti + Te
TCT = 60 seconds / f (RR)
How do you calculate body surface area
Body surface area is the patient’s height in inches x pounds lbs
, Divided by 3131, and then the square root
= M2
List 8 parameters which should be set in assit-control volume control ventilation ( VC-CMV)
1) VT
2) F = BPM
3) inspired gas flow L/min
4) flow wave form
5) I:E ratio
6) pressure limit
7) inflation hold
8) PEEP
What formula can be used to estimate the level of Pressure support needed?
Use the formula for Transairway pressure.
PIP - Pplateau
What is a good percentage of peak inspiratory flow to start at for flow cycling
A cycle criteria of 40% of peak flow is an appropriate starting point for patients with COPD
Using a low flow cycling value 10% may be appropriate for patients with restrictive disorders
What are the 3 ways of establishing a PIP during PCV?
1) The initial PIP be set to Pplateau level taken during taken during VC-CMV
2) if Pplateau is not available then use PIP level from VC-CMV minus 5cm H20 as a starting point
3) if volume settings are not available then use 10-15 cm H20 as a starting point with simultaneous volume measure measurement and adjust appropriately
What are the initial setting of BiPAP?
IPAP 5-10cm H20 increase 3-5 cm H20 until
Explain how to estimate Palv During PC-CMV
Observation of the flow curve can allow estimation of the alveolar pressure during PCCMV. If low drops to zero prior to the end of inspiration, the set pressure is reaching the alveolar level by the end of inspiration. If load is not dropped to zero before inspiration ends, alveolar pressure is less than the set pressure
