Page 18 - 2026 SMOG

VENTILATOR MANAGEMENT
Ventilator Transfer Procedure
1. Ensure ETT is secure; document the size and position of ETT at the teeth. Clamp the tube
immediately before disconnecting the patient from the ventilator to maintain PEEP if
conducting recruitment maneuvers or if PEEP is 10 or higher; then unclamp only after being
connected to a new ventilator circuit.
2. Coordinate ventilator settings with the transferring physician, anesthesia provider, or respiratory
therapist. Verify settings, review ABG analysis, and review current SpO and EtCO readings.
2
2
Place those settings on the transport ventilator and place the patient on the transport ventilator
early to verify patient tolerance and compatibility.
3. ABG should be done within 30min of flight. If time allows, the patient should be on a transport
ventilator for at least 15min prior to transport.
4. Ventilator settings for the en route care team should initially be matched to those of the
transferring facility. Adjust settings as needed in order to maintain appropriate clinical
parameters listed on the first page of the ventilator management protocol or the transferring
physician’s orders.
5. Ensure adequate sedation and analgesia medications are on hand.
Ventilator Calculations
• Target EtCO :
2
˚ (Current Rate × Current EtCO )/Desired EtCO = New Rate
2
2
˚ NOTE: You may incur a pressure limitation alarm after adjusting to the new rate for EtCO 2
targeting on the Hamilton T1 Ventilator due to Peak pressure increase.
• Vent Adjustments Due to Abdominal/Thoracic Pressure:
˚ Current Minute Ventilation/New Rate (New Rate = Current Rate + 1 or 2) = New Tidal
Volume. Now set the new rate and new tidal volume.
˚ NOTE: Pressure alarm may not go away, and may need to be recalculated after several
minutes if SpO has not improved
2
• Minute Ventilation (VE):
˚ Rate × Tidal Volume = VE
• Ideal Body Weight (IBW):
˚ Men: [(Height in inches—60) × 2.2] + 50
Women: [(Height in inches—60) × 2.2] + 45.5
˚
• Driving Pressure (ΔP):
˚ Plateau Pressure (Pplat)—PEEP = Driving Pressure
˚ Hamilton T1 Plateau Pressure Calculation: Pplateau = (VTEmL/CstatmL/cmH O) +
2
PEEPcmH O. This is needed to calculate the driving pressure on a Hamilton T1
2
Reference: CPG ID: #48 (Mechanical Ventilation During Critical Care Air Transport); #92 (Mechanical
Ventilation Basics)

10 • GENERAL