Version May 2024
| Setting | Volume-limited | Pressure-limited | Notes | |
| Volume-limited assist control ventilation | Synchronized intermitted mechanical ventilation with pressure support | Pressure-limited assist control ventilation | ||
| Tidal volume | 6 mL/kg PBW* | 6 mL/kg PBW* | Inspiratory pressure is set to target an approximate desired tidal volume (refer below) | Range is 6 to 8 mL/kg non-ARDS patients; 4 to 8 mL/kg ARDS patients. |
| Ventilator rate | 16 to 30 breaths per minute | 16 to 30 breaths per minute | 16 to 30 breaths per minute | Higher rates may be necessary for patients with ARDS (eg, ≤35 breaths per minute). |
| PEEP | 5 to 10 cm H2O | 5 to 10 cm H2O | 5 to 10 cm H2O | Higher levels are appropriate in patients with ARDS or severe hypoxemia. Lower levels are appropriate if an air leak is present or in patients without lung injury (eg, 5 cm H2O). |
| FiO2 | FiO2 to target SpO2 90 to 96%¶ | FiO2 to target SpO2 90 to 96%¶ | FiO2 to target SpO2 90 to 96%¶ | A lower limit may also be appropriate (eg, a PaO2 of 55 mmHg and an SpO2 of 88% in patients with hypercapnic hypoxemic respiratory failure. Higher limits may be necessary in certain conditions.Δ |
| Inspiratory flow | 60 to 70 L/minute; ramp pattern Target an I:E ratio of 1:2 to 1:3◊ | 60 to 70 L/minute; ramp pattern Target an I:E ratio of 1:2 to 1:3 | 60 to 70 L/minute; ramp pattern Target an I:E ratio of 1:2 to 1:3 | Higher rates up to 75 L/minute that increase the I:E ratio are appropriate in patients with airflow obstruction. |
| Trigger sensitivity | 2 L/minute (flow-triggered) –1 to –2 cm H2O (pressure triggered) | 2 L/minute (flow-triggered) –1 to –2 cm H2O (pressure triggered) | 2 L/minute (flow-triggered) –1 to –2 cm H2O (pressure triggered) | Pressure triggering should not be used when auto-PEEP is suspected. |
| PSV level | N/A | 5 to 10 cm H2O | N/A | PSV may be adjusted to target a desired tidal volume for unsupported breaths. |
| Inspiratory pressure | N/A | N/A | Variable (typically between 12 and 25 cm H2O) | The initial inspiratory pressure varies depending upon lung compliance, airway resistance, and tubing resistance. Values should be adjusted to consistently achieve tidal volume that will result in a minute ventilation to minimize hypercarbia and avoid excessively high airway pressures. |
ARDS: acute respiratory distress syndrome; FiO2: fraction of inspired oxygen; I:E ratio: inspiratory:expiratory ratio; PaO2: arterial oxygen tension; PBW: predicted body weight (ie, ideal body weight); PEEP: positive end-expiratory pressure; PSV: pressure support ventilation; SpO2: peripheral oxygen saturation.
* Females: PBW (kg) = 45.5 + 0.91 × (height [cm] – 152.4); males: PBW (kg) = 50 + 0.91 × (height [cm] – 152.4).
¶ Patients are often started on an FiO2 of 1 immediately after intubation and weaned quickly over 30 minutes to reach the minimum FiO2 needed to achieve the target SpO2.
Δ Conditions where higher FiO2 is indicated include carbon monoxide toxicity, cluster headaches, sickle cell crisis, pneumothorax, pregnancy, and air embolism.
◊ Pressure-regulated volume-controlled ventilation sets an inspiratory time rather than setting the inspiratory flow to target the same I:E ratio.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
