Page 268 - Clinical Application of Mechanical Ventilation

234 Chapter 8

SUMMARY

Initiation of mechanical ventilation requires many decisions, ranging from the mode of
ventilation to the level of PEEP. Nevertheless, this process can be simplified by follow-
ing a set of established guidelines. Under most clinical conditions, the initial settings
on the ventilator will satisfy the immediate requirement for most patients.
It is essential to remember that the initial settings are just that; subsequent changes
to these settings must be made based on the ever-changing condition of the pa-
tient. In summary, Table 8-14 outlines the indications for mechanical ventilation and
Table 8-15 provides an overview of the initial ventilator settings for an adult patient.

TABLE 8-14 Indications for Mechanical Ventilation

Indication Parameters

Acute ventilatory failure PaCO .50 mm Hg (Higher for
2
COPD)
pH ,7.30
Apnea

Impending ventilatory failure Tidal volume ,3 to 5 mL/kg
Frequency .25 to 35/min
Minute ventilation .10 L/min
Vital capacity ,15 mL/kg
MIP ,220 cm H O
2
Rising PaCO .50 mm Hg
2
Severe hypoxemia PaO ,60 mm Hg at F O .50%, or
2
2
1
PaO ,40 mm Hg at any F O 2
2
1
PaO /FIO (P/F ratio): ≤300 mm Hg
2
2
for ALI, ≤200 mm Hg for ARDS
Prophylactic ventilatory support Reduce risk of pulmonary
complications
Prolonged shock
Head injury
Smoke inhalation
Reduce hypoxia of major body
organs
Hypoxic brain
Hypoxia of heart muscles
Reduce cardiopulmonary stress
Prolonged shock
Coronary artery bypass surgery
Other thoracic or abdominal
surgeries
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