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H ow to pick initial settings for a Multiple Choice test

H ow to pick initial settings for a Multiple Choice test. Mechanical Ventilation. Key words. Disease Height and/or weight ABG Age Gender . Answer Components . Mode Vt RR FiO2 PEEP. Tidal Volume. 8-10 ml/kg normal 6-8 ml/kg ARDS 4-8 ml/kg Asthma

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H ow to pick initial settings for a Multiple Choice test

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  1. How to pick initial settings for a Multiple Choice test Mechanical Ventilation

  2. Key words • Disease • Height and/or weight • ABG • Age • Gender

  3. Answer Components • Mode • Vt • RR • FiO2 • PEEP

  4. Tidal Volume • 8-10 ml/kg normal • 6-8 ml/kg ARDS • 4-8 ml/kg Asthma • Determine IBW based on given height • Or use weight given • Find the range

  5. RR and Minute Ventilation • RR x Vt determine minute ventilation • After determining the Vt choose a RR that will create the MV you want • 5-10 lpm normal range • 7-8 for average patient • Low end for COPD • High end for CHI

  6. Mode • Either A/C or SIMV for full control • SIMV for COPD and Asthma • PCV in either A/C or SIMV for ARDS

  7. Example patient • You 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 ABG’s are pH 7.28, PaCO2 58, HCO3 26, and PaO2 63, SpO2 91%. Which of the following initial vent settings would be appropriate?

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

  9. Example patient • You have a 48 year old, 5’8” male with pneumonia who has developed sepsis. He is currently on a NRB mask with a RR of 25 and shallow breathing. His ABG’s are pH 7.28, PaCO2 58, HCO3 26, and PaO2 63, SpO2 91%. Which of the following initial vent settings would be appropriate?

  10. Example patient • You have a 48 year old, 5’8” male with pneumonia who has developed sepsis. He is currently on a NRB mask with a RR of 25 and shallow breathing. His ABG’s are pH 7.28, PaCO2 58, HCO3 26, and PaO2 63, SpO2 91%. Which of the following initial vent settings would be appropriate?

  11. Example patient • You have a 48 year old, 5’8” male with pneumonia who has developed sepsis. He is currently on a NRB mask with a RR of 25 and shallow breathing. His ABG’s are pH 7.28, PaCO2 58, HCO3 26, and PaO2 63, SpO2 91%. Which of the following initial vent settings would be appropriate?

  12. IBW • Male IBW 106 + [6 x (height in inches-60)] • 106 + [6 x (68 – 60)] • 106 + [6 x 8] • 106 + 48 • 154 pounds • ÷ 2.2 = 70 kg

  13. Easier IBW • [(Height in inches – 60) x 6] + 106 • [(68 – 60) x 6] + 106 • (8 x 6) = 106 • 48 + 106 • 154 lbs • ÷ 2.2 = 70kg

  14. Tidal Volume • 70 kg IBW • Use normal range for pneumonia 8-10ml/kg • 70 x 8 = 560ml • 70 x 10 = 700ml • Tidal volume should be between 560-700ml

  15. example • Once you have determined Vt range you need to check your options • A) Assist Control, RR 10, Vt 800ml, FiO2 1.0, PEEP 5 • B) SIMV, RR 14, Vt 500ml, FiO2 0.5, PEEP 5 • C) Assist Control, RR 14, Vt 600ml, FiO2 0.5, Peep 10 • D) SIMV, RR 12, Vt 650ml, FiO2 1.0, PEEP 5

  16. Find the right Vt • A) Assist Control, RR 10, Vt800ml, FiO2 1.0, PEEP 5 • B) SIMV, RR 14, Vt500ml, FiO2 0.5, PEEP 5 • C) Assist Control, RR 14, Vt600ml, FiO2 0.5, Peep 10 • D) SIMV, RR 12, Vt650ml, FiO2 1.0, PEEP 5 • Both A and B can be eliminated due to the Vt being out of range • That leaves C and D

  17. Minute ventilation • C) Assist Control, RR 14, Vt600ml, FiO2 0.5, Peep 10 • D) SIMV, RR 12, Vt650ml, FiO2 1.0, PEEP 5 • Minute ventilation for C is 8.4L • Minute ventilation for D is 7.8L • Because both C and D meet the Vt range and the Minute Ventilation range it is time to look at FiO2

  18. FiO2 • C) Assist Control, RR 14, Vt 600ml, FiO2 0.5, Peep 10 • D) SIMV, RR 12, Vt 650ml, FiO2 1.0, PEEP 5 • The patient is already on an FiO2 of 1.0 • That makes D the best choice to maintain the FiO2 of 1.0 • It 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

  19. Mode • Assist Control and SIMV are both acceptable for a pneumonia patient as long as they are giving a full minute ventilation

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