Page 269 - Clinical Application of Mechanical Ventilation

Initiation of Mechanical Ventilation 235

TABLE 8-15 Initial Ventilator Settings

Parameter Setting Notes

Mode Assist/Control or SIMV Provide ventilatory support.

f 10 to 12/min Primary control to regulate ventilation.
Guided by PaCO .
2
V T 10 to 12 mL/kg Peak inspiratory pressure is directly
related to the V setting.
T
Use lower V (e.g., 6 to 8 mL/kg) to reduce
T
risk of pressure-related lung injuries.
F O 2 100% for severe 40% for mild hypoxemia or normal
I
hypoxemia or cardiopulmonary status.
compromised
cardiopulmonary status

PEEP ≥5 cm H O for refractory Monitor patient and note cardiovascular
2
hypoxemia adverse effects.
I:E 1:2 to 1:4 1:4 for patients needing longer E time
due to air trapping.
Flow pattern (Constant) Other flow patterns for a lower peak
inspiratory pressure (manometer) and
better gas distribution (breath
sounds).

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Self-Assessment Questions

1. Which of the following is not an indication for mechanical ventilation?
A. acute ventilatory failure
B. impending ventilatory failure
C. severe hypoxemia
D. airway obstruction

2. A patient has an admitting diagnosis of acute ventilatory failure. This condition is characterized by a
PaCO of _______ mm Hg or greater with an accompanying respiratory _______.
2
A. 20, acidosis C. 50, acidosis
B. 20, alkalosis D. 50, alkalosis

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