Page 15 - 2026 SMOG

VENTILATOR MANAGEMENT
Clinical Indications Contraindications
• Patient received from the transferring facility, • Equipment malfunction/failure
intubated, and requires ventilator support.
• Patient requiring intubation in the field and
subsequent respiratory support
Procedure
• Turn on the ventilator and ensure that the machine is functional and that the battery is charged.
• Attach ventilator circuit, O hose to machine/O supply, EtCO and any required attachments
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If Patient “Newly” Placed on Ventilator, INITIAL Settings:
Volume Controlled Parameter Pressure Controlled
14 (CMV+, AC, or SIMV) RATE 14 (P-AC or PCV)
6cc/kg TIDAL VOLUME See NOTE 3
5cmH O PEEP 5cmH O
2 2
1:2 I:E 1:2
100% FiO 100%
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• NOTE 1: After a few minutes on initial settings, adjust settings prn to maintain appropriate
clinical parameters
• NOTE 2: Patients “newly” on a ventilator will start on volume mode unless patient pathology
requires pressure mode
• NOTE 3: Set pressure to target VTE 6cc/kg IBW (Pressure <30cmH O). Recommend starting
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at 15–20cmH O.
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• NOTE 4: IBW calculation:
˚ MEN: [(Height in inches—60) × 2.2] + 50
WOMEN: [(Height in inches—60) × 2.2] + 45.5
˚
If Patient is a “Transfer” and Already on Ventilator Settings:
• Match/maintain ventilator settings from the medical treatment facility initially
• See Ventilator Transfer Procedure below
Normal Parameters:
• Respiratory Rate: 10–30
• Tidal Volume: 4–8mL/kg IBW
• FiO : 21–100%*
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• PEEP: 5–20cmH O*
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• I:E: 1:2–1:4
• SpO : 90–96%
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*NOTE: FiO /PEEP should be adjusted in concert per the chart below if the patient has ARDS or
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if desaturation is gradual and presumed to be caused by patient pathology.
To achieve oxygenation goals, set FiO to 30% and start titrating FiO and PEEP in concert based
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on the chart. Go up every 5–10min, quicker if low SpO sats develop.
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(continues)
2026 Standard Medical Operating Guidelines (SMOG) • 7