Ventilator Setting for Lung Protection

Author: Jenny Wilson, MD
Updated: 10/14/2011

Ventilator Setting for Lung Protection

Lung protection: Strategy for patients with lung injury and those prone to lung injury. This applies to every intubated patient except those with acute asthma/COPD.

Initial ventilator setting for patient with predicted body wt = 70 kg (5'9" male; 5'11" female)

  • Mode = Volume Assist Control (AC)
  • Tidal volume = 350-560 mL
  • Inspiratory flow rate = 60 L/min
  • Respiratory rate = 16
  • FiO2 = 100%
  • PEEP = 5
  • Goal plateau P <30 cmH2O

Ventilator Mode

Volume Assist Control (AC)

Tidal Volume (Vt)


  • Based on predicted body weight (kg)
  • If acute lung injury (ALI) or ARDS present, goal is to bring down to 6 mL/kg
  • Do NOT alter to fix ventilation, but may need to alter if plateau pressure is > 30 cmH2O, see below). Only protects lung by preventing barotrauma.

Inspiratory Flow Rate (IFR)


  • Increase IFR and ensure adequate sedation if patient uncomfortable or sucking on tube

Respiratory rate (RR)

Start at 16-18, then adjust based on pCO2 (VENTILATION)

  • Goal pH = 7.30 - 7.45
  • Goal pCO2 = mild hypercarbia


Start at FiO2 100% and PEEP 5 (OXYGENATION)

  • Goal PaO2=55-80 or SpO2=88-95%
  • Wait 5-15 min, then draw an ABG
  • If ABG and SpO2 show adequate oxygenation, drop FiO2 to 30-40% and begin titrating FiO2 and PEEP per the chart below to achieve oxygenation goal.

FiO2 and PEEP chart

Plateau Pressure (Pplt)

  • Goal Pplt <30 cmH2O
  • Check after initial settings, and at regular intervals thereafter
  • Technique: Press inspiratory hold button for 0.5 sec and look at pressure gauge
  • If Pplt >30 cmH2O, lower Vt until you acheive your goal
  • May need to go as low as 4 mL/kg of predicted body weight


  • NHLBI ARDS Network, "Ventilator Protocol Card" [Source]
  • Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000 May 4;342(18):1301-8. [PubMed]