Adjusting Mechanical Ventilation

Page 3 of 4

Fixing respiratory
Respiratory
acidosis acidosis should be fixed before
when fixing There are three choices to consider
hypoxemia.
1. Increase the
respiratory
• Use
tidal
acidosis. 6 – 8 ml/kg of PBW for patients
volume
•with
Usenormal
4 – 6 ml/kg of PBW for patients with poor
compliance.
ARDS, acute
compliance. Theselungpatients
injury, ormaypulmonary
have fibrosis.
elevated plateau
Patients with poor compliance have
• Increasing
pressures the≥ 30tidal
cm volume may also improve
ventilation. This may be a good choice when the
oxygenation
h2O.
ventilation by
and increasing alveolar
patient is having trouble with both
2. Increase
oxygenation.
the rate rate can be increased beyond the initial
• The
Changing the rate may be a good idea when
range of 10 to 20
changes breaths per minute.
choices tofall outside
change thethetidal volume
• Don’t forget, COPD patients
acceptable tidal volume range. may not tolerate high
timebecause
rates to emptythey eachneed breath
a longer
from their lungs.
3. Remove
• Deadspace changes have only a small impact on
deadspace
space only
ventilation. when small
Therefore, improvements
remove dead
• Remove deadare
in ventilation space
needed.
•toAdd deadCO2.
remove space
Exam to add CO2.
• You should over ventilate patients with increased
Tips
This will help reduce the
intracranial
• Respiratory pressures
acidosis on
shouldthe exam.
be fixed before
intracranial pressure.
fix the respiratory acidosis are unacceptable,
hypoxemia.
means fixing However, if the only choices to
choose
• Patients the next
are best
whofirst. answer, even
hyperventilating if it
(low
hypoxemia
management or anxiety control.pain
Other causes
PaCO2) may
hypoxemia. simply need better
of low PaCO2
• Patients include fever
with atelectasis andmore from a tidal
benefit
increase.
volume increase rather than a rateif the plateau
• Do not increase the tidal volume
Increasing the tidal volume will increase the
pressure
Remember is close
to to to 30 cm H20.
plateau pressure an unacceptable level.
do no harm.

Page 4 of 4
COMPLETE & CONTINUE !
• Do not try to correct a chronically elevated
(compensated)
PaCO2 in a patient with a normal
pH.
Fixing
Hypoxemia
Hypoxemia occurs when the PaO2 is less than 80 mm
order:
Hg. Correct hypoxemia in the following
1. First, increase the
2. Next,
FiO2 up increase
.60 the PEEP until the patient improves
toincrease
3. Finally,