Mayo Protocols B

Question 1

ASV protocol: exclusion criteria

Answer 1

Patient weight is less than 3 kg
Minute ventilation is greater than 20 L
Neurogenic or erratic/uncontrollable breathing patterns w/periods of apnea
Extreme obesity (unless PEEP adequately set using transpulmonary catheter)

Question 2

ASV protocol: Initial ASV settings:

Answer 2

Set gentler and IBW

Set ASV pressure limit to 30. (High pressure alarm auto-sets 10 above this)

Question 3

ASV Protocol: How do you set the % Minute Volume?

Answer 3

New patients: 100% for normal lungs, 90% COPD, 150% ARDS

Current patients: Set to match patient VE on previous mode or VE from operating room

Question 4

ASV  Protocol: Sub Settings
PEEP
Trigger
ETS
Preamp
TRC

Answer 4

PEEP: Per PEEP table or PV Tool
Trigger: 2-3
ETS: 25% (default) or 40% for COPD’ers
Pramp: 25-50 ms
TRC: ETT Size & 100%

Question 5

You have a patient on ASV. The P0.1 is more negative than -3. What should you do?

Answer 5

Temporarily switch to pressure trigger of 1 and assess P0.1 under “monitor” tab.
If still less than -3, increase %MinVol until control rate matches spont rate

Question 6

Do not set %MinVol less than ___.

Answer 6

70%

Question 7

How do you measure plateau pressure without doing a breath hold?

Answer 7

On AC mode, add an inspiratory pause of 0.3. (The vent will automatically calculate it.)

Question 8

How do you measure transpulmonary pressure?

Answer 8

Use an esophageal manometry catheter. (Remember, transpulmonary driving pressure is more accurate than Pplat - PEEP)

Question 9

How is transpulmonary diving pressure calculated?

Answer 9

PtransI (End INSpiration transpulmonary pressure)
Minus
PtransE (End EXPiration transpulmonary pressure)

Question 10

What is a normal compliance value for intubated adults and peds?

Answer 10

Intubated adults: >50 ml/cm H2O

Intubated peds: 0.5 mL/cm H2O per Kg of actual weight

Question 11

What is a normal P0.1?

Answer 11

Normal = 0 to -3
Moderate or increased WOB: -3 to -5
Excessive effort: -5 or less