1. RC 210 Chapter 7 Lecture 1

2. Primary Goal Overall primary goal of mechanical ventilation is to meet the oxygen and carbon dioxide requirements for patients who cannot do so themselves. Goal is achieved by appropriately setting the ventilator to maintain an adequate minute volume.

3. Minute Volume f Vt

4. Determining Initial Vent Settings Volume Ventilation V t f Flow Waveform I:E Ratio Pressure Limit Inflation Hold Inspiratory Pressure Expiratory Pressure

5. Determining Initial Vent Settings Volume Ventilation Settings dependant upon specific type of ventilator used.

6. Initial Settings Volume Ventilation Normal body metabolism Total oxygen consumption of about 250 ml/min Carbon dioxide production of about 200 ml/min. Lungs provide ventilation and gas exchange to meet these needs. Heart circulates the blood and nutrients (Oxygen to the cells, and CO 2 from the cells back to the lungs)

7. Initial Settings Volume Ventilation Normal body metabolism cont. Minute volume and cardiac output parallel the metabolic rate. When metabolism increases (fever, sepsis, infection) ventilation and cardiac output must increase to meet the overall demand.

8. Initial Settings Volume Ventilation Tidal Volume and Rate Normal spontaneous V t is about 5 to 7 ml/kg. Normal f is about 12 to 18 breaths/min. Equals a normal minute volume of about 100 ml/kg ibw.

9. Initial Settings Volume Ventilation Calculating IBW Women: IBW = 105 + 5(H-60) Men: IBW = 106 + 6(H-60) Height is always in inches.

10. Initial Settings Volume Ventilation Tidal Volume (V t ) Range Adults - 6-12 ml/kg IBW Infants and Children – 5 to 10 ml/kg IBW

11. Initial Settings Volume Ventilation Tidal Volume cont. Tidal volume varies depending on lung pathology. Normal lungs (Drug OD or Post op) Vt 10 – 12 ml/kg) Obstructed lungs (COPD or Asthma) Vt 8 – 10 ml/kg Restricted lungs (ARDS or Fibrosis) Vt 4 – 8 ml/kg* *Overall goal to achieve an adequate minute volume so you will need to use low Vt and high f’s. Control panel shows the amount of gas sent by the vent, but not all of the volume reaches the patient. Some is lost because of leaks and tubing compliance.

12. Initial Settings Volume Ventilation Tidal Volume Risks Higher than 12 ml/kg can cause high pressures and accompanying over distension and trauma Lower than 4 ml/kg can contribute to atelectasis. Peep may be necessary for lower volumes Video 1 Video 2

13. Initial Settings Volume Ventilation Calculate Vt 1.62 yo Male 6’ 2”, 260lbs 2.14 yo Female 5’ 2”, 160lbs 3.82 yo Male 5’ 8”, 460lbs 4.2 yo Male 2’ 2”, 60lbs 5.32 yo Male 6’ 6”, 200lbs 6.18 yo Female 5’ 6”, 120lbs 7.62 yo Female 4’ 9”, 95lbs 8.43 yo Female 5’ 4”, 160lbs 9.18 mo Male 38”, 20lbs 10. 1 do Male 12”, 3.2lbs