initial ventilator setup
Mode: Assist Control with Decelerating Flow [aka PRVC, CMV with Autoflow]
This most reliably takes over the work of breathing for a patient with cardiorespiratory failure.
Tidal Volume: 6 mL/kg (predicted body weight)
Keeping the tidal volume in a physiologic range is the most important step toward reducing ventilator-induced lung injury, and it has been shown to reduce mortality by about 9%. Please note that this is predicted, and not actual, body weight! You'll need to know the patient's height and gender.
Rate: Sufficient for a minute ventilation of 6 L/min
[divide 6000 by the tidal volume to get the rate]
The higher the minute ventilation, the more CO2 you'll blow off.
FiO2: 100% to start
[lower it as much as you can, but keep the SpO2 ≥ 90%]
PEEP: 5 cm for lungs that look pretty good on the CXR
10 cm for lungs that look pretty bad on the CXR
15 cm for lungs that look really bad on the CXR
Positive end expiratory pressure keeps vulnerable alveoli from collapsing and helps recruit lung units that would otherwise be flooded. This reduces intrapulmonary shunt. The more white stuff in the lungs, the more PEEP you need.
Goal PaO2: 55-80
[adjust the PEEP and FiO2]
Goal pH: 7.25-7.45
[adjust the vent rate, keeping the tidal volume at 6 mL/kg PBW]