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)

6-8 mL/kg (LUNG PROTECTION)

• 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)

60-80 L/min (PATIENT COMFORT)

• 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

FiO2 & PEEP

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.

EMCrit.org

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

References

• 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]