Ventilatory Settings (Jonathan Cheng)

3 main modes:
1.
Mandatory/Mechanical
- work of breathing is taken over by ventilator ccompletely
- must have poor GCS/sedated if not they will fight tube
- typical after RSI in A&E, set at tidal volume of 5-7ml/kg, 12-14 breaths/min
- can either control pressure/ volume (control volume if dont want too big a volume to gush into cases
like bullae emphysema/COPD lungs
2.
SIMV (Synchronized Intermittent Mandatory Ventilation)
- this is used to wean patient off complete MV
- can set at 500mls 6 breaths/min, on top of what patient is breathing on his own
- patients still sedated to prevent fighting
- can be with or without pressure support (lowest 8cm H20)
- regular series of breaths are scheduled but the ventilator senses patient effort and reschedules
mandatory breaths based on the calculated need of the patient
3.
SponVent
- with or without pressure support in the form of BiPAP, CPAP, SV (pure sponven)
BiPAP has I and E:
10cm H20 and 5cmH20 pen release analogy
BiPAP difference is equivalent to CPAP 5 cmH20
PEEP more than 15 is considered high
Look at airway resistance using the Ppeak and graph: should be as tombstone as possible, a diagonal upslope is
indicative of difficulty expanding lungs due to increased time reaching the peak (high airway pressures)
In this case, consider tweaking PEEP to decrease the collapse to help the tombstone pattern be
achieved easier
All pressures are measured in cmH20
Calculate Pa02/Fi02