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Typical Ventilator Settings:
There are no “typical” settings for every patient. Just as treatment modalities differ from patient to patient, so it is with ventilators. The following are guidelines that may be used for the “average” patient.
Tidal volume 10-15 ml/kg
Respiratory rate 10-15 breaths per minute
Inspiratory flow 40-60 liters per second
Sigh rate 1-2 times per minute with VT=20 ml/kg
PEEP 0-5 cm H20
Aspiration may occur before, during, and/or after intubation.
Most ventilator patients should have their hands restrained.
Pseudomonas pneumonia frequently develops due to contaminated equipment.
Endotracheal Tube Problems:
Arterial circulation is occluded by ET cuff pressures that exceed 30 mm Hg. The resulting tracheal stenosis and malacia may be prevented by decreasing the cuff pressures of the ET tube. An easy way to minimize this problem is to auscultate at the neck for the sound of rushing air while inflating the ET tube cuff. Do not inflate the tube past the point where the sound of rushing air disappears.
Always be alert for the signs of an occluded, whether partial or complete, ET tube (decreasing SaO2, poor skin color, etc.).
Be alert for a displaced ET tube particularly after moving the patient
There are four ventilator modes. There are only two ventilatory modes to consider, assist and control. The other two modes, assist-control and IMV, are merely variations of the first two.
Assist: The patient initiates a breath and the ventilator is triggered to allow the airflow. The patient must have a drive to breathe.
Control: The ventilator controls the patient and will not allow any “extra” breaths of air. Typically, the patient will be unconscious or under the influence of a paralytic.
Assist-control: The base respiratory rate is set, however if the patient wishes to take any additional breaths he/she may. Hyperventilation may occur with this setting due to the fact that the VT remains the same whether it was a controlled breath (ventilator) or a patient initiated breath.
Intermittent Mandatory Ventilation (IMV): This setting basically works the same as assist control with one major difference. Any spontaneous breaths that are initiated by the patient will have no ventilatory support, that is to say the VT will be entirely dependent on the patient.
Ventilators today are extremely reliable and dependable; however, they are machines and as such are capable of breaking down (usually at the worst possible times). Ventilator problems are potentially the most serious. The major problem is simply inadequate VT.
Inadequate VT caused by:
Leaks in the ventilator circuit or the ET cuff
Disconnected tubing or ventilator
Obstruction of airflow
Biting on the ET tube
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