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Basic ventilatory parameters
The document outlines key ventilatory parameters essential for achieving desired minute ventilation and adequate gas exchange while minimizing lung injury. It details basic parameters such as tidal volume, respiratory rate, and peak pressures, along with specific guidelines for different patient conditions like ARDS and OAD. Monitoring strategies and adjustments are emphasized to optimize ventilatory support and prevent complications.
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Basic ventilatory parameters
- 1. Basic Ventilatory Parameters Dr.Ankit Gajjar
- 2. Primary goal • Achievea desired minute ventilation that matches the patient's metabolic needs • Adequate gas exchange • Minimal lung injury
- 3. Basic parameters • Tidalvolume • Respiratory rate • Minute ventilation • Lung Pressures – Peak Pressure – Platue pressure • Flow / Inspiratory time / I:E ratio • Flow pattern • Trigger • FiO2 • PEEP
- 4. Tidal Volume • Amountof air delivered with each breath • 8 ml/kg (IBW) • ARDS – 6 ml/kg • PC variable • VC fixed • Avoid very high tidal volumes to prevent volume trauma
- 5. Respiratory Rate • Neuro,post operative patients – 14-18 • ARDS – 28-34 • OAD – 12-14 prevention of air trapping • Septic, Acidotic patients – 28-34 • Monitor – pH – PCO2 – Air trapping
- 7. Minute ventilation • Monitor •Normal – 6-8 LPM • Achieve desired – pH – PO2
- 8. Pressures • PC –Set driving pressure Pi – To achieve desired tidal volume • VC – monitor Ppeak, Pplatue – Ppeak – peak inspiratory pressure • Function of resistance and compliance – Pplatue – inspiratory pressure during inspiratory hold • Function of lung comliance • Target <30 cm H2O • Important in prevention of Barotrauma
- 10. Peak flow • Maximumflow delivered by the ventilator during inspiration • Normal Peak flow rate - 60 L per minute • Higher rates are frequently necessary – Acidotic patient – OAD • Insufficient peak flow rate is – Dyspnea – Spuriously low peak inspiratory pressures, and scalloping
- 12. Flow pattern • Canbe chosen in VCV • In PCV always ramp wave • square wave (constant flow) • ramp wave (decelerating flow) • The ramp wave is preferred – distribute ventilation more evenly particularly in OAD – decreases peak airway pressure, physiologic dead space, and PaCO2
- 14. Inspiratory time /I:E ratio • Normal – 1:2 • ARDS – 1:1/ 1:1.5 • OAD – 1:3-1:5 or even prolonged • Look for adequate expiratory time on flow time scaler • Inadequate expiratory time causes air trapping
- 16. Trigger • Pressure trigger –Drop of pressure in airway due to patient effort • Flow trigger – Returned flow is less then delivered flow – More sensitive decreases WOB • Keep 1-3 – More sensitive – auto trigger – Less sensitive – increased WOB
- 17. FiO2 • The lowestpossible FiO2 to meet oxygenation goals should be used • To decrease the likelihood that adverse consequences of supplemental oxygen – absorption atelectasis – accentuation of hypercapnia – airway injury parenchymal injury • Most patients - >88% • >95% – ACS – CVA – Post cardiac arrest – pregnant
- 18. PEEP • Avoid endexpiratory alveolar collapse • Usual – 5 • Lesser – OAD??? – BPF • Higher – ARDS
- 19. VCV for 60kg male Condition Airway protection ARDS OAD Septic Acidotic VTE 420-480 240-360 400-450 450-500 RR 16-18 28-34 12-14 28-34 I:E 1:2 1:1-1:2 1:3-1:6 1:2 Flow pattern decelerating Decelerating Decelerating decelerating Trigger Flow 3 Flow 3 Flow 3 Flow 3 FiO2 30 30-100 30 30 PEEP 5 5-20 0-5 5
- 20. Monitor • Pplat • MV •SPO2 • PCO2 • pH
- 21.