This document provides guidance on mechanical ventilation settings for different clinical situations. It discusses initializing ventilation and monitoring patients on ventilators. Key points include: - Setting initial parameters like PIP, PEEP, respiratory rate and FiO2 for pressure control mode ventilation - Understanding how these parameters function, like PIP controlling tidal volume and PEEP preventing atelectasis - Monitoring for delivered tidal volume, minute ventilation, respiratory rate and oxygenation goals - Adjusting settings appropriately based on patient's lung health, like using higher PEEP for asthma/COPD to keep airways open

1. Initiation Of Mechanical
Ventilation

2. Before Connecting to
Ventilator
ET position and fixing
ET cuff pressure 30cm /7-10cc air
Air entry confirmation bilaterally
Good i.v. access
Sedation and Paralysis
NIBP/Mannual BP , Pulse Oxymeter
Assembled Ventilator electricity,O2

3. Before Connecting to
Ventilator(Contd…)
Assembled Ventilator Suction,
Compressed air, Vent. tubings, HMEF,
Catheter mount, Inline suction/Catheters
Basic Ventilatory settings already dialed

4. Basic Settings in Pressure
Control Mode
Peak Inspiratory/Airway Pressure- PIP /PAP
15 to 20 c m
PEEP – 0 - 5 c m
Respiratory Rate 16 to 20/min
FiO2 0.5 to 1
Inspiratory Time or I/E ratio 1sec or 1:2
Trigger
Rise time/Ramp/Ascend time

5. Understanding of PCV, what we
preset
PIP- Pressure will rise to this level
during inspiration and airway pressure
will not go above this level thus least
chances of barotrauma. VT depends
on this.
PEEP- Minimum Pressure level
throughout the respiratory cycle.
Prevents atelectasis

6. Understanding of PCV, what we
preset
RR/Frequency- We preset RR. Thus
minimum this number of breaths are
delivered per minute. Patient trigger
rate is more than preset RR Vent. Will
obey that rate.
FiO2 / Oxygen Percentage 0.6
I/E ratio-1:2 - 3 I time - 0.8 to 1.2 sec
Expiration depends on RR & I time

7. Setting up of Alarms…. (and
responding to them!)
Low VT High VT
Low M.V. High M.V.
High RR
Leak /Low airway pressure

8. Clinical Monitoring
Sudden tachycardia, Hypotension
Chest Expansion
Respiratory effort/distress, accessory
muscles, sweating
Reduced air entry in any area
Drop in Oxygen Saturation.

9. Watch for actually delivered
parameters
VT - 6 to 8 ml/kg
Min.Ventilation. 5 to 10 lit /min
RR- > 25/min.Tachypnoea suggests
hypoventilation/agitation/central in
origin

10. Goals to be achieved in PCV
Deliver optimum VT 6 to 8ml/kg in
lowest possible PIP
Achievement of good oxygenation(PO2
or O2 Sats) with fiO2 < 0.6, Add PEEP
to achieve this.
Relieve Respiratory efforts completely
Think of weaning !

11. Normal Lung Ventilation
Post Op (Non Lung) patients
Neurological patients- CVA, Poisonings,
Meningo-encephalopathies, N-M causes
Post arrest status
‘Primum Non Nocere’
(First of all do no harm)

12. Lungs are diseased
Asthma, COPD exacerbations
Congestive Cardiac Failure
Lung Infections

13. Normal Lung Ventilation
‘Primum Non Nocere’
Tracheobronchial tree and alveolo-capillary gas
exchange surface are intact and healthy.
Minimum PIP, Lowest PEEP, Lowest fi02,
Physiological RR
Avoid repeated ABGs, Unnecessory suctions
and try your level best to avoid
VAP
Avoid P.A.L.I. (P…… Asso. Lung Injury)

14. Asthma & COPD exacerbs.
Optimisation of PEEP to keep airway open
during expiration. If Possible measure
intrinsic PEEP & dial PEEP to Splint it.
Judicious high PIP to deliver adequate VT
In COPDs- high enough to wash Pathological
Hypercapnoea but never aim for
normocapnoea
Higher RR to wash CO2
Higher I/E ratios

15. Congestive Cardiac Failures
Correct adjustment of PEEP is crucial
Low PEEP- inadequate resolution of
Pulmonary Edema and thus
inadequate ventilatory support.
High PEEP- Hypotension and
aggravation of CCF.
Relieve Respiratory distress completely

16. Lung Infections
Lowest possible PEEP to prevent injury
to normal lung zones
Ancillary therapy is equally important
Humidification, Nebulisation, Suctioning
Physiotherapy, Positioning,
Bronchoscopy.