Ventilation SOP

Question 1

Outline the contents of the ventilation SOP

Answer 1

Crucial for optimisation of gas exchange and managing the patient’s physiology.

General strategies incluiding standard parameters
Specific conditions:
- OOHCA/TBI dealt with in respective SOPs
- Asthma
- Spont breathing

Question 2

What is the general principle of ventilation of LNAA patients?

Answer 2

Open lung
High PEEP low TV

Targets:
- 94-98%
- ETCO2 3.5-4.5

Question 3

What would be your initial vent set up for most patients?

Answer 3

TV 6-8ml/kg
PEEP 5
RR 15
FiO2 100%
I:E ratio 1:2

Question 4

Describe how you would optimise oxygenation in the ventilated patient

Answer 4

Increase FiO2
Increase PEEP
Use respiratory hold to recruit

Question 5

Describe how you would optimise ETCO2 in the ventilated patient

Answer 5

Increase RR/VT
Deepen sedation
Cool the patient

Question 6

What strategies would you use to ventilate the asthmatic patient?

Answer 6

Accept CO2 clearance may be challenging
Consider using BiPAP mode
Maintain PEEP 5 and cautiously increase Pmax
Treat gas trapping:
- Reduce RR, lengthen I:E ratio
- Disconnect and manually decompress

Question 7

What would be your approach to ventilating the spontaneously breathing patient?

Answer 7

Sedate/paralyse
Use synchronised vent modes if happy