INITIAL VENTILATOR SETTINGS

*Prior to first use, ensure ventilator (as applicable) has been pre-set to utilize parameters of the user’s choice. Some ventilators may be preset to deliver an inspiration time (I-Time) instead of an I:E ratio. Some ventilators default to Volume or Pressure, which would need to be checked prior to use. Failure to appropriately set up and save these ventilator settings may delay use of the ventilator.

1. MODE: Assist Control (AC) or Adaptive Support Ventilation (ASV) -Hamilton-T1 only

Ensure the setting is either Volume or Pressure support. Some ventilators default to different settings.

2. Breaths Per Minute/Respiratory Rate: 14BPM (10-30 range)

3. TIDAL VOLUME (VT): 6ml/kg IBW (4-8ml/kg IBW range)

Quick Reference: (Detailed reference in Appendix C)

Male

66” = ~380cc [min: 255 / max: 510]

69” = ~420cc [min: 283 / max: 566]

72” = ~465cc [min: 310 / max: 621]

75” = ~505cc [min: 338 / max: 676]

Female

60” = ~273cc [min: 182 / max: 364]

63” = ~314cc [min: 210 / max: 419]

66” = ~356cc [min: 237 / max: 474]

69” = ~397cc [min: 265 / max: 530]

4. Fraction of Inspired Oxygenation (FiO2): 21 - 100% (0.21-1.0) (low flow O2 @ 3 LPM (liters per minute) = ~ 40% FiO2 [flowrate on Saros oxygen concentrator])

5. Inspiratory-to-Expiratory (I:E) Ratio: 1:2

6. Positive End-Expiratory Pressure (PEEP): 5 [Range 5-20 cmH20]

7. Pressure Support: 5 [Range 5-20 cmH20] Consider adding if the patient has airway edema or is being ventilated through a narrower diameter ETT.

INITIAL SETTINGS

NOTE: Initial Ventilator settings are based on the patient's ideal body weight (IBW) and clinical condition. However, “basic” or standard starting points are necessary to begin treatment.

1. Set the ventilator to Volume Assist/Control. Consider pressure support if patient meets a clinical need.

2. Set driving mechanics by type of ventilation. Tidal Volume at 4-6 mL/kg IBW (Average adult male is 500 mL).

3. Set rate to maintain an appropriate minute ventilation (VE) of 4-8 L/min (VT x Rate = VE).

- For a MV of 6L and a VT of 500, set the rate at 12.
- Continuous capnometry or capnography is the standard for invasive airway management and should be used to monitor ventilations and as a tool to increase or decrease frequency. EtCO2 is especially important for monitoring TBI cases.
- It is advisable to set the respiratory rate close to what the intrinsic rate was prior to sedation and or paralysis as that rate was likely compensating for some metabolic derangement and just reflexively setting it to a “normal rate” might precipitate worsening acidosis.

4. Set appropriate PEEP. Minimum of 5 cmH2O. Start there and titrate up as needed. In hypoxic patients, consider starting at 10 cmH2O but take extreme caution if also hypotensive as PEEP may worsen BP.

5. Set Fi02. Depending on clinical condition the patient may need high Fi02. Start at 100% and rapidly titrate down to 40% using arterial blood gas and SpO2 data. Do not rely on Sp02 alone (if possible).1

6. Set Inspiratory: Expiratory Ratio (I:E) to 1:2 for most patients. Adjust to clinical conditions.

7. Oxygen requirements can be roughly calculated using Minute Ventilation x FiO2 fraction to determine LPM of pure O2 required (e.g., VE of 6 LPM @ 50% FiO2 (0.5) = 3 LPM bottled or generated O2 required.)

NOTE: Full D cylinder is ~425 liters O2 at 2200psi (i.e. ~141minutes O2 @ 3 LPM requirement above). Calculations should account for discrepancies in tank fill, leaks, dead space, etc. (consider a planning factor of 1.5-2 X calculated requirement).

Recommendation

It is important to test ventilator settings prior to attaching to the patient. A recommendation is to have a test training lung with the equipment. An XL exam glove taped to the circuit is a field expedient test lung. This can ensure the ventilator is appropriately performing.