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).

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.