Know to pick initial settings for a Multiple Choice test

How to pick initial settings for a Multiple Choice testMechanical Ventilation

Key wordsDiseaseHeight and/or weightABGAgeGender

Answer Components ModeVtRRFiO2PEEP

Tidal Volume8-10 ml/kg normal6-8 ml/kg ARDS4-8 ml/kg Asthma

Determine IBW based on given heightOr use weight givenFind the range

RR and Minute VentilationRR x Vt determine minute ventilationAfter determining the Vt choose a RR that will create the MV you want5-10 lpm normal range7-8 for average patientLow end for COPDHigh end for CHI

ModeEither A/C or SIMV for full controlSIMV for COPD and AsthmaPCV in either A/C or SIMV for ARDS

Example patientYou have a 48 year old male with pneumonia who has developed sepsis. He is currently on a NRB mask with a RR of 25 and shallow breathing. His ABGs are pH 7.28, PaCO2 58, HCO3 26, and PaO2 63, SpO2 91%. Which of the following initial vent settings would be appropriate?

Example patientA) Assist Control, RR 10, Vt 600ml, FiO2 1.0, PEEP 5B) SIMV, RR 14, Vt 700ml, FiO2 0.5, PEEP 5C) Assist Control, RR 14, Vt 600ml, FiO2 0.5, Peep 10D) SIMV, RR 12, Vt 650ml, FiO2 1.0, PEEP 5

Example patientYou have a 48 year old, 58 male with pneumonia who has developed sepsis. He is currently on a NRB mask with a RR of 25 and shallow breathing. His ABGs are pH 7.28, PaCO2 58, HCO3 26, and PaO2 63, SpO2 91%. Which of the following initial vent settings would be appropriate?

Example patientYou have a 48 year old, 58 male with pneumonia who has developed sepsis. He is currently on a NRB mask with a RR of 25 and shallow breathing. His ABGs are pH 7.28, PaCO2 58, HCO3 26, and PaO2 63, SpO2 91%. Which of the following initial vent settings would be appropriate?

Example patientYou have a 48 year old, 58 male with pneumonia who has developed sepsis. He is currently on a NRB mask with a RR of 25 and shallow breathing. His ABGs are pH 7.28, PaCO2 58, HCO3 26, and PaO2 63, SpO2 91%. Which of the following initial vent settings would be appropriate?

IBWMale IBW 106 + [6 x (height in inches-60)]106 + [6 x (68 60)]106 + [6 x 8]106 + 48154 pounds 2.2 = 70 kg

Easier IBW[(Height in inches 60) x 6] + 106[(68 60) x 6] + 106(8 x 6) = 10648 + 106154 lbs 2.2 = 70kg

Tidal Volume70 kg IBW Use normal range for pneumonia 8-10ml/kg70 x 8 = 560ml70 x 10 = 700mlTidal volume should be between 560-700ml

exampleOnce you have determined Vt range you need to check your optionsA) Assist Control, RR 10, Vt 800ml, FiO2 1.0, PEEP 5B) SIMV, RR 14, Vt 500ml, FiO2 0.5, PEEP 5C) Assist Control, RR 14, Vt 600ml, FiO2 0.5, Peep 10D) SIMV, RR 12, Vt 650ml, FiO2 1.0, PEEP 5

Find the right VtA) Assist Control, RR 10, Vt 800ml, FiO2 1.0, PEEP 5B) SIMV, RR 14, Vt 500ml, FiO2 0.5, PEEP 5C) Assist Control, RR 14, Vt 600ml, FiO2 0.5, Peep 10D) SIMV, RR 12, Vt 650ml, FiO2 1.0, PEEP 5

Both A and B can be eliminated due to the Vt being out of rangeThat leaves C and D

Minute ventilationC) Assist Control, RR 14, Vt 600ml, FiO2 0.5, Peep 10D) SIMV, RR 12, Vt 650ml, FiO2 1.0, PEEP 5

Minute ventilation for C is 8.4LMinute ventilation for D is 7.8LBecause both C and D meet the Vt range and the Minute Ventilation range it is time to look at FiO2

FiO2C) Assist Control, RR 14, Vt 600ml, FiO2 0.5, Peep 10D) SIMV, RR 12, Vt 650ml, FiO2 1.0, PEEP 5

The patient is already on an FiO2 of 1.0That makes D the best choice to maintain the FiO2 of 1.0It is also not a good choice to start with a PEEP above 5, such as in C, unless the patient was on more than 5 before intubating

ModeAssist Control and SIMV are both acceptable for a pneumonia patient as long as they are giving a full minute ventilation