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    Common Ventilatory Settings

    Uploaded by

    Hamza Ishtiaq
    The document discusses common ventilator settings such as fractional inspired oxygen, tidal volume, respiratory rate, and peak inspiratory flow rate. It also covers factors like minute ventilation, inspiration/expiration ratio, and sighs. The document emphasizes the importance of providing proper humidification and thermoregulation to the ventilated patient by heating and saturating the delivered air.

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    Download as PPTX, PDF, TXT or read online from Scribd

    Common Ventilatory Settings

    Uploaded by

    Hamza Ishtiaq
    20 views22 pages
    The document discusses common ventilator settings such as fractional inspired oxygen, tidal volume, respiratory rate, and peak inspiratory flow rate. It also covers factors like minute ventilation, inspiration/expiration ratio, and sighs. The document emphasizes the importance of providing proper humidification and thermoregulation to the ventilated patient by heating and saturating the delivered air.

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    Common Ventilatory settings

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    The document discusses common ventilator settings such as fractional inspired oxygen, tidal volume, respiratory rate, and peak inspiratory flow rate. It also covers factors like minute ventilation, inspiration/expiration ratio, and sighs. The document emphasizes the importance of providing proper humidification and thermoregulation to the ventilated patient by heating and saturating the delivered air.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    20 views22 pages

    Common Ventilatory Settings

    Uploaded by

    Hamza Ishtiaq
    The document discusses common ventilator settings such as fractional inspired oxygen, tidal volume, respiratory rate, and peak inspiratory flow rate. It also covers factors like minute ventilation, inspiration/expiration ratio, and sighs. The document emphasizes the importance of providing proper humidification and thermoregulation to the ventilated patient by heating and saturating the delivered air.

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    Common Ventilatory Settings

    And
    Humidification + Thermoregulation

    Dr Munawar Ali
    Dr Nadeem
    Common Ventilator Settings
    parameters/ controls

    • Fraction of inspired oxygen (FIO2)


    • Tidal Volume (VT)
    • Peak Flow/ Flow Rate
    • Respiratory Rate/ Breath Rate / Frequency
    ( F)
    • Minute Volume (VE)
    • I:E Ratio (Inspiration to Expiration Ratio)
    • Sigh
    ● Fraction of inspired oxygen (FIO2)

    • The percent of oxygen concentration that the


    patient is receiving from the ventilator. (Between
    21% & 100%)
    (room air has 21% oxygen content).

    • Initially a patient is placed on a high level of FIO2


    (60% or higher).

    • Subsequent changes in FIO2 are based on ABGs and


    the SaO2.
    • In adult patients the initial FiO2 may be set at 100% until
    arterial blood gases can document adequate oxygenation.

    • An FiO2 of 100% for an extended period of time can be


    dangerous ( oxygen toxicity) but it can protect against
    hypoxemia

    • For infants, and especially in premature infants, high levels


    of FiO2 (>60%) should be avoided.

    • Usually the FIO2 is adjusted to maintain an SaO2 of greater


    than 90% (roughly equivalent to a PaO2 >60 mm Hg).

    • Oxygen toxicity is a concern when an FIO2 of greater than


    60% is required for more than 25 hours
    Signs and symptoms of oxygen toxicity :-

    1- Flushed face

    2- Dry cough

    3- Dyspnea

    4- Chest pain

    5- Tightness of chest

    6- Sore throat
    ● Tidal Volume (VT)
    • The volume of air delivered to a patient during a
    ventilator breath.

    • The amount of air inspired and expired with each


    breath.

    • Usual volume selected is between 5 to 15 ml/ kg


    body weight)
    • In the volume ventilator, Tidal volumes of 10 to 15
    mL/kg of body weight were traditionally used.

    • the large tidal volumes may lead to (volutrauma)


    aggravate the damage inflicted on the lungs

    • For this reason, lower tidal volume targets (6 to 8


    mL/kg) are now recommended.
    ● Peak Flow/ Flow Rate
    • The speed of delivering air per unit of time,
    and is expressed in liters per minute.

    • The higher the flow rate, the faster peak


    airway pressure is reached and the shorter
    the inspiration;

    • The lower the flow rate, the longer the


    inspiration.
    ● Respiratory Rate/ Breath
    Rate / Frequency ( F)

    • The number of breaths the ventilator will


    deliver/minute (10-16 b/m).

    • Total respiratory rate equals patient rate plus


    ventilator rate.

    • The nurse double-checks the functioning of the


    ventilator by observing the patient’s respiratory
    rate.
    For adult patients and older children:-
    With COPD

    • A reduced tidal volume


    • A reduced respiratory rate

    For infants and younger children:-

    • A small tidal volume


    • Higher respiratory rate
    ● Minute Volume (VE)
    • The volume of expired air in one minute .

    • Respiratory rate times tidal volume equals


    minute ventilation
    VE = (VT x F)

    • In special cases, hypoventilation or


    hyperventilation is desired
    In a patient with head injury,

    • Respiratory alkalosis may be required to promote


    cerebral vasoconstriction, with a resultant decrease
    in ICP.

    • In this case, the tidal volume and respiratory rate


    are increased
    ( hyperventilation) to achieve the desired alkalotic
    pH by manipulating the PaCO2.
    In a patient with COPD

    • Baseline ABGs reflect an elevated PaCO2 should not


    hyperventilated. Instead, the goal should be
    restoration of the baseline PaCO2.

    • These patients usually have a large carbonic acid


    load, and lowering their carbon dioxide levels
    rapidly may result in seizures.
    ● I:E Ratio (Inspiration to
    Expiration Ratio):-
    • The ratio of inspiratory time to expiratory
    time during a breath
    (Usually = 1:2)
    ● Sigh
    • A deep breath.

    • A breath that has a greater volume than the tidal volume.

    • It provides hyperinflation and prevents atelectasis.

    • Sigh volume :------------------Usual volume is 1.5 –2 times tidal


    volume.

    • Sigh rate/ frequency :---------Usual rate is 4 to 8 times an


    hour.
    ● Peak Airway Pressure:-
    • In adults if the peak airway pressure is
    persistently above 45 cmH2O, the risk of
    barotrauma is increased and efforts should
    be made to try to reduce the peak airway
    pressure.

    • In infants and children it is unclear what level


    of peak pressure may cause damage. In
    general, keeping peak pressures below 30 is
    desirable.
    ● Pressure Limit
    • On volume-cycled ventilators, the pressure limit dial
    limits the highest pressure allowed in the ventilator
    circuit.

    • Once the high pressure limit is reached, inspiration


    is terminated.

    • Therefore, if the pressure limit is being constantly


    reached, the designated tidal volume is not being
    delivered to the patient.
    ● Sensitivity(trigger Sensitivity)
    • The sensitivity function controls the amount of
    patient effort needed to initiate an inspiration
    • Increasing the sensitivity (requiring less negative
    force) decreases the amount of work the patient
    must do to initiate a ventilator breath.
    • Decreasing the sensitivity increases the amount of
    negative pressure that the patient needs to initiate
    inspiration and increases the work of breathing.
    • The most common setting for pressure
    sensitivity are -1 to -2 cm H2O
    • The more negative the number the harder it
    to breath.
    Ensuring humidification and
    thermoregulation

    • All air delivered by the ventilator passes through the water


    in the humidifier, where it is warmed and saturated.

    • Humidifier temperatures should be kept close to body


    temperature 35 ºC- 37ºC.

    • In some rare instances (severe hypothermia), the air


    temperatures can be increased.

    • The humidifier should be checked for adequate water levels


    • An empty humidifier contributes to drying the
    airway, often with resultant dried secretions, mucus
    plugging and less ability to suction out secretions.

    • Humidifier should not be overfilled as this may


    increase circuit resistance and interfere with
    spontaneous breathing.

    • As air passes through the ventilator to the patient,


    water condenses in the corrugated tubing. This
    moisture is considered contaminated and must be
    drained into a receptacle and not back into the
    sterile humidifier.
    • If the water is allowed to build up, resistance is
    developed in the circuit and PEEP is generated. In
    addition, if moisture accumulates near the
    endotracheal tube, the patient can aspirate the
    water.

    • The nurse and respiratory therapist jointly are


    responsible for preventing this condensation
    buildup. The humidifier is an ideal medium for
    bacterial growth.

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