Initial Settings and Weaning Parameters

Initial RR Setting

10-20bpm

Initial RR Setting for SIMV on VC

6-10 bpm

What are the special considerations for RR on VC?

• Ve = 5-8L/min

• Up to 20

What are the special considerations for RR on PC?

• Up to 20

• Or same as previous setting on VC mode

What are the initial settings for VT on AC/VC?

6-8ml/IBW

What are the special considerations for VT on AC/VC?

• Keep Pplat < 30

• Keep PIP < 40

Initial settings on Pinsp (above PEEP)

Pplat on VC

Special considerations on Pins above PEEP

• PIP - PEEP (if Pplat not known)

• Adjust to achieve target VT of IBW

• 15-25 = good start

  • < 35cmH2O

Initial settings for FiO2

40-60% if not known

What are the special considerations for FiO2 on VC or PC?

• 100% for emergencies or unstable

• If patient on O2:

  • match their prior FiO2

Initial Settings for PEEP on VC or PC

3-5cmH2O

What are the special accommodations for PEEP on VC?

• Max is 8cmH2O

What are the special accommodations for PEEP on PC?

• Higher for ARDS

• Same as prior settings from VC

What are the initial settings for Flow on VC?

40-60L/min

What are the special considerations for Flow on VC?

• Consider I:E ratio, IT

  • ex: I:E = 1:2

• Pressure trigger -1 to 1cmH2O

• Flow trigger 1-3L/min

Initial Settings for IT/I:E ratio on AC/PC?

0.8-12 sec

• I:E Ratio goal = 1:2

Special considerations for IT/I:E ratio on AC/PC

• Obstructive: longer exp times

• ARDS: may use IRV (Inverse ratio ventilation) to improve oxygenation → 2:1

What are the alarm settings for High Pressure?

10-15cmH2O above PIP

What are the alarm settings for Low Pressure?

10cmH2O below PIP

What are the alarm settings for High Frequency?

10-15 above observed rate 

What are the alarm settings for Low Frequency?

10 below observed rate

What are the alarm settings for High Minute Volume?

3-5L above observed MV

What are the alarm settings for Low Minute Volume?

2-3 below observed Minute Ventilation

What are the alarm settings for high VT?

200-300mL above observed VT

What are the alarm settings for Low VT?

100mL below observed VT

What are the apnea alarm settings?

20 seconds

IBW for Male 5ft and over equation

106 + 6 (total inches - 60inches)

IBW for Female 5ft and over equation

105 + 5 (total inches - 60inches)

IBW for Male under 5ft equation

106 – 2 (inches under 5 feet)

IBW for Female under 5ft equation

105 – 2 (inches under 5 feet)

Initial Settings for BIPAP for IPAP

Inspiratory positive airway pressure (IPAP)= 8-12 cmH2O (up to 15)

• Increase 3-5 cmH2O to improve ventilation

Initial Settings for BIPAP for EPAP

Expiratory positive airway pressure (EPAP)= 4-6 cmH2O (up to 8)

• Increase 2-5 cmH2O to improve oxygenation

• When EPAP is increased, remember to increase IPAP same amount to maintain Pressure Support (PS) to maintain ventilation

  • Remember IPAP-EPAP= PS

What is a normal vital capacity? in weaning.

65-75 mL/kg

• (10 x VT)

What is an acceptable value in vital capacity?

≥ 10 mL/kg

• (2 x VT)

What’s an unacceptable value in Vital Capacity?

< 10 mL/kg

• (< 2 x VT)

What is a normal MIP or NIF aka diaphragm strength in weaning from the vent?

80cmH2O

What is an acceptable MIP or NIF when weaning from the vent?

20 cmH20

What is an unacceptable MIP or NIF when weaning from the vent?

< 20 cmH20

What is a normal value for RR or Frequency for weaning from the vent?

12-20/min

What is an acceptable value for RR or Frequency for weaning from the vent?

8-20 /min

What is an unacceptable value for RR or Frequency for weaning from the vent?

• > 20 /min

• < 8 /min

What is a normal value for a Spontaneous VT when weaning from the vent?

5-8 mL/kg

What is the acceptable value for Spontaneous VT when weaning from the vent?

≥ 5 mL/kg

What is the unacceptable value for Spontaneous VT when weaning from the vent?

< 5 mL/kg

What is a normal value for Minute Ventilation when weaning from the vent?

5-6 L/min

What is an acceptable Minute Ventilation when weaning from the vent?

< 10 L/min

What is an unacceptable Minute Ventilation when weaning from the vent?

> 10 L/min

What is the normal value for Maximum Expiratory Pressure (aka secretion management → coughing)?

• 160 cmH20

  • double MIP

What is an acceptable Maximum Expiratory Pressure (MEP) (aka cough)?

40 cmH20

What is an unacceptable Maximum Expiratory Pressure (MEP) (aka cough)?

< 40 cmH20