Ventilator Settings

Priscilla

Pembimbing: dr. Adhrie S, SpAn-KIC

Jenis ventilator mekanik
• Servo S by Maquet
• Savina by dragger
• Hamilton
Ventilator settings
1. Mode
2. Tidal volume (cc)
3. Respiratory rate (RR)
4. Inspired oxygen concentration (FiO2)
5. Positive end expiratory pressure (PEEP)
6. Inspiratory time
1. Modes Assist Control
Volume Control
(ACVC)
• Differ in the way MVe is delivered to Volume Control
the patient SIMV-VC
• Same : adjustments of FiO2 and PEEP
Assist Control
Pressure Control
(ACPC)
Pressure Control

SIMV-PC

Spontaneous PS
ACVC SIMV-VC
• Set: TV, RR, FiO2, PEEP • Set: TV, RR, FiO2, PEEP, Pressure
support (boost to patients own
effort)
ACPC SIMV-PC
• Set: Pins (associated Vt • Set: Pins, RR, FiO2, PEEP,
dependent on patients current Pressure support (boost to
compliance), RR, FiO2, PEEP patients own effort)
Pressure support
• Set: PS, PEEP, FiO2
• Not for paralyzed or brain dead patient
2. Tidal volume (Vt)
• Normal spontanueous Vt for healthy adults 5-7 mL/kg with spontaneous RR 12-18
x/min
• Ventilated patients:
 Adults : 6-8 mL/kg IBW
 Infants & children : 4-8 mL/kg IBW
• Adult’s lungs do not get larger as he/she gains weight
Example: Female, 66 inches tall (165 cm)
PBW = 105 + 5 (66-60) = 135 lb / 2.2 = 61.4 kg
Vt = 6-8 x 61.4 kg = 368 – 490 mL
• Vt depend on lung pathlogy
• When setting tidal volume (VT) and rate, the goal is not to focus so
much on the exact VT and rate, but to focus on using settings that do
not harm the patient
• Risks during setup Vt:
 Overdistention of lung tissue
 Repeated opening and closing (recruitment/derecruitment) of
alveoli
 Atelectasis formation
 Inadequate Vt setting
3. Respiratory rate
DuBois BSA Formula
• Initial frequency : 12-18 x/min

• Ventilator frequency primarily control to regulate PaCO2

• ↑ frequency if PaCO2 is too ↑
• ↓ frequency if PaCO2 is too ↓
DuBois BSA Chart
4. Inspired oxygen concentration (FiO2)
• Initially 100%  severe hypoxemia, abnormal cardiopulmonary
functions (post resuscitation, smoke inhalation, ARDS)
• After stabilization  FiO2 < 50%
• Evaluated and changed accordingly by means of subsequent blood
gas analyses and correlated with pulse oximetry trending
5. Positive end expiratory pressure (PEEP)
• Initially set 3-5 cmH2O
• Restores FRC and physiological PEEP that existed prior to intubation
• Contraindication:
 Hypotension
 ↑ ICP
 Uncontrolled pneumothorax
6. I:E Ratio
• The I:E ratio is the ratio of inspiratory time to expiratory time
• Range between 1:2 and 1:4.
• A larger I:E ratio (longer E ratio) may be used on patients needing
additional time for exhalation because of the possibility of air trapping and
auto-PEEP

I time (Ti) = Time for each Breath x [ I ratio / sum of I:E ratio]

Rate 16 x/m, Desired I:E Ratio 1:4

Ti = [60 s/16x] x [1/1+4] = 3.75 s x 1/5 = 0.75 s
P-Peak (Peak Inspiratory Pressure)
• Reflects airway resistance and
lung compliance (work required
to move air through airways and
into alveoli)
• Elevated with either increased
resistance or decreased
compliance
 • Tpause : time for no flow/pressure
Volume Control delivery (%). Setting 0.0-30% atau
0-1.5 sec
• T insp rise : time taken to reach
peak inspiratory flow/pressure at
the start of each breath
 Adults range is 0 to 0.40 seconds
 Infants range is 0 to 0.20 seconds
• Trigger : level of patient effort to
trigger the ventilator to initiate
inspiration. Higher number > 0 
more sensitive to patient efforts
Volume and Pressure Support
Alarm Settings
• Low: 5-10 cmH2O below PIP
Pressure • Upper: 10 cmH2O above PIP

• Low : 10-15% below average MV

MV

• 2-5 cmH2O below PEEP level

PEEP

• 20 detik
Apnea
Terimakasih