M: 106 + 6(x) / 2.2 F: 105 + 5 (x)/ 2.2

high = 10 above what the patient is doing Low = 5 below (if vent has low option) do not pass 30!

High = 10 above Low = 2 below (on PRVC) Or 12-20

High = Double what PT is doing Low = 500mL or 1 under what PT is doing

High = 3 above what the pt is doing Low = 3 under what the pt is doing

turn the vent on never put pt on dead device

get a ABG

Smallest pressure needed in order to achieve set VT Delivers a target tidal volume but continually adjusts the amount of pressure needed to use the lowest amount of pressure to reach that set tidal volume. Inspiratory flow is variable and changes with patient effort and lung mechanics (airway resistance, lung compliance). The vent initially delivers a volume test breath upon starting PRVC. From there, it will calculate the needed pressure to deliver that set tidal volume, and then switch to a pressure breath with continual adjustments from that point. The vent will not make adjustments of more than 3 cmH2O of pressure with each breath. The vent will also deliver volume test breaths at other times as well such as after the rate is changed or after high pressure alarm. PRVC breaths can be more comfortable for the patient and are beneficial as they respond to changes in compliance to ensure the desired tidal volume.

set tidal volume (VT) over a set inspiratory time (we are controlling volume) Airway pressures will vary depending on compliance and lung mechanics.

Normal volume range is 6 to 8 mL/kg of ideal body weight (IBW). Lung protective volume range is 4 to 6 mL/kg of ideal body weight.

the ventilator raises the circuit pressure to a set pressure above the set PEEP, and maintains that pressure for the set inspiratory time. The set pressure is constant, but the tidal volume will vary depending on compliance and lung mechanics. If the Pressure Control is set to 15 cmH20, and the PEEP is set to 5 cmH20. The airway pressure will be held at 20 cmH20 for the set inspiratory time with each breath. Pressure Control may be determined by first using volume breaths to see the peak inspiratory pressure (PIP) needed to deliver the desired tidal volume. The Pressure Control can then be set by subtracting PEEP from the PIP. Pressure breaths may be more comfortable for the patient when compared to volume breaths, and they help to protect against barotrauma. Use caution in patients with compliance or resistance issues. Patients with higher airway pressures may not get adequate tidal volumes.

determine how easy it is for patient to take a breath

the constant flow that is in the circuit

when the vent notices a deflection of bios flow due to the patient taking a breath positive or 2 = easier measured in liters per minute

Patients with neuromuscular disease (Guillain-Barré syndrome & Myasthenia gravis)

When the vent detects a negative deflection in airway pressure below baseline negative or -2 = harder (measured in cm/H2O)

trauma

inverse relationship I time goes up = pressure and flow go down I time goes down = pressure and flow go up

pressure and flow has a direct relationship

0.9-1.2

faster lower I time = faster flow

slower longer I time = slower flow

pressure at the highest point (peak) of inspiratory breath

the pressure measured in the alveoli during an inspiratory hold

HME Heated Circuit

Post op Transport short term ER

Peds Trach Long term thick secretions

a measurement of pulmonary compliance when there is no airflow (insp pause); It's a way to measure the elastic resistance of the lungs at a fixed volume with relaxed muscles. or Alveolar Distention measured during an inspiratory hold; compliance during periods with no gas flow

tidal volume / Pplat-Peep

compliance during periods with gas flow

tidal volume / Pip-Peep

Dry side of inspiration

Vibrating Mesh Neb

Tidal volume, MV, sats, and PIP increases volumes / pressures increase

Desired PaO2 x Known FIO2 / Known PaO2

Known PaCO2 x Known RR / Desired PaCO2

Male: 40-50 mL/cmH2O Female: 35-40 mL/cmH2O

RR/VT (liters)

it is a physiological index that measures the ratio of a patient's respiratory rate to their tidal volume.

to help predict if a patient can be weaned off mechanical ventilation.

to prevent barotrauma

barotrauma ARDS Pneumonia

bronchospasms mucous plug kinked ET Tube

10-15 cmH2O above PIP

poor lung compliance bronchospasm tension pneumothorax mainstem intubation poor sedation (over-breathing) tube biting / tubing kinks coughing mucous plugs / secretions poor positioning filter issue.

5-10 cmH2O below PIP Never set to 0.

cuff leak poor sedation (over-breathing) loose / disconnected circuit

20 seconds

Elevated PaCO2 can be corrected with an increase in rate or tidal volume.

can be corrected with a decreased in RR or tidal volume.

I-time is the time of the inhalation phase of a breath.

I:E ratio

1:2 or 1:3

I + E = X 60 seconds / X = RR

An elevated PIP with normal Pplat = upper airway / resistance issues with normal lung compliance. Pplat raises = PIP raise

Increased tidal volume Decreased pulmonary compliance Pulmonary edema / effusion

the rate and either volume or pressure are set the patient is sedated and makes no respiratory effort, so they will only get the control breaths at the set rate. When the patient triggers a breath, they receive an assist breath. The assist breath will be whatever tidal volume or pressure we have set.

Delivers constant PEEP (like a CPAP mask) but will also provide pressure support breaths for spontaneous breaths taken by the patient. This mode will default to giving mandatory breaths based on apnea backup settings.

Set rate, set tidal volume, set pressure support. If the patient is not making any spontaneous effort, this mode functions the same as A/C. The first time in a breath cycle when patient triggers a breath, the patient receives a full assist breath. For each breath after that until the next breath cycle, the volume is whatever patient draws themselves along with pressure support. The patient still receives a set minimum number of breaths (the set rate) and any other breaths are determined by the patient. SIMV mode helps to prevent breath stacking and Auto PEEP. Pressure support should be set 5-10 cmH2O above PEEP (10 is a good starting point).

by the ventilator and the ventilator performs the work of inspiration during those breaths.

by the patient, but the ventilator performs at least some of the work of inspiration for those patient initiated breaths.

by the patient and the patient performs the entire work of inspiration for those patient initiated breaths.

the amount of air that moves in and out of the lungs during each breath or respiratory cycle

keeps airway pressure higher than atmospheric pressure at the end of exhalation aka keeps lungs open

the stress on the respiratory system during a breath.

Pplat - PEEP

the condition of the lungs and the risk of ventilator-induced lung injuries.

14 cmH2O