Respiratory Therapy Cave

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Mechanical Ventilator Guidelines and Calculators

Ideal Tidal Volume for Women Ideal Tidal Volume for Men Initial Vent settings per protocol:
(Based on 6-10ml/kg IBW) (Based on 6-10ml/kg IBW) 1. FIO2: 40% (PO2 >92%)
Height Kg Min Max Height Kg Min Max 2. VT: 6-10 ml/kg IBW (for acute
VT VT VT VT lung injury use 6 ml/kg IBW)
3. PRVC: 10-14 BPM
5’0” 50 300 500 5’0” 53 318 530
4. PEEP: 5
5’1” 52.5 315 525 5’1” 56 336 560 5. ABG 30 minutes post set-up
5’2” 55 330 550 5’2” 59 354 590 6. Automode: per RT discretion
5’3” 57.5 345 575 5’3” 62 372 620 7. Maintain cuff pressure >20
5’4” 60 360 600 5’4” 65 390 650 8. Suction and send sputum to lab
5’5” 62.5 375 625 5’5” 68 408 680 9. Perform oral care Q2 hours
5’6” 65 390 650 5’6” 72 426 710 10.Elevate HOB 40 degrees
5’7” 67.5 405 675 5’7” 75 444 740
5’8” 70 420 700 5’8” 78 462 770 Stop wean or spontaneous mode if:
5’9” 72.5 435 725 5’9” 81 480 800 1. Change in BP >20
5’10” 75 450 750 5’10” 84 498 830 2. SpO2<92% or as specified by Dr.
5’11” 77.5 465 775 5’11” 87 516 860 3. RR over 30>5 minutes
6’0” 80 480 800 6’0” 90 534 890 4. VT <5ml/kg IBW
6’1” 82.5 495 825 6’1” 93 552 920 5. HR >20% above baseline
6’2” 85 510 850 6’2” 96 570 950 6. Pt. apneic, anxious, diaphoretic, or
6’3” 87.5 525 875 6’3” 99 588 980 other indications of stress.
6’4” 90 540 900 6’4” 103 606 1010
6’5” 92.5 555 925 6’5” 106 624 1040 Optimal Peep: Increase PEEP by 2-3 Q20
minutes. If static compliance, P/F Ratio
6’6” 95 570 950 6’6” 109 642 1070 &/or SpO2 go up, it’s working. Stop when
6’7” 97.5 585 975 6’7” 112 660 1100 P/F Ratio = >200, or when static compliance
6’8” 100 605 1000 6’8” 115 678 1130 decreases, P/F Ratio decreases or BP
6’9” 102. 620 1025 6’9” 118 696 1160 decreases. Do not increase PEEP if
systolic BP <90. Also keep MAP <15, as it
5 6’10” 121 714 1190 usually drops before cardiac output. Ideally,
6’10” 105 635 1050 6’11” 124 732 1220 Static Compliance should be between 60-100
6’11” 107. 650 1075 7’0” 127 750 1250
5
Considerations for readiness to wean patient from ventilator:
1. Awake and alert. 13. A-a gradient < 300
2. Able to follow commands 14. a-A ratio > 50% or PaO2/FiO2 >150 – 200
3. Spontaneously breathing 15. Underlying condition resolved
4. Adequate cough 16. Secretions thin and minimal
5. Pain controlled 17. Chest X-Ray improving
6. No obvious signs of respiratory distress 18. Adequately nourished (Albumin >2.5)
7. Little to no anxiety 19. Electrolytes stable (CA, Mg, K)
8. FIO2 =< 40 and PEEP =<5 20. Adequate hemoglobin (>8-10g/dl) & Hct (>25% or baseline)
9 TEMP < 100.4 (no seizures, sepsis) 21. Absence of bowel problems (Diarrhea, constipation, ileus)?
10. Hemodynamically stable: 22. Weaning parameters within normal limits
a. Systolic BP > 90 mmHg a. NIF > 20 b. VC >10ml/kg IBW (2*VT)
b. Pulse >50 < 120 c. VE < 10 d. VT > 5ml/kg IBW
c. No Dopamine infusion > 5 mcg/kg d. RR < 30 e. RSBI < 100 (VT/RR)
11. SPO2 > 90% or normal for patient 23. PS pt using in automode must be at pt weaning level.
12. ABGs normal for patient a. PS = Plateau (Static) Pressure - PEEP
13. P.01 <4.2 (calculated in spont. Mode) b. Normal PS usually at least < or = 10