Page 196 - 2023 SMOG Digital

VENTILATOR MANAGMENT

CLINICAL INDICATIONS:
• Patient received from transferring facility, intubated, and requires ventilator support.
• Patient requiring intubation in the field and subsequent respiratory support.
CONTRAINDICATIONS:
• Equipment malfunction / failure.
PROCEDURE:
• Turn on ventilator and ensure that machine is functional and battery is charged.
• Attach ventilator tubing and O2 tubing to machine. PA.10 Simple & Tube Thoracostomy
PA.11 Needle Thoracostomy
• If patient is a transfer and already on vent, maintain ventilator PA.12 Ventilator Management
settings from medical treatment facility.
If patient “newly” on ventilator, initial settings include: PA.123 754 Preflight and Troubleshooting
PA.14 731 Preflight and Troubleshooting
• Mode: Assist Control (AC) / CMV+ or ASV (Hamilton T1 only). PA.15 COVID-19 Management
AC / CMV+ are the preferred modes over ASV. PA.1p Pediatric Airway
• Tidal Volume (Vt): Initially 6cc/kg, (Ideal Body Weight (IBW) PA.2 Airways Pearls
then adjust based on ventilatory needs (4-8cc/kg) PA.3 Airway Confirmation
 IBW calculation for Predicted Body Weight in Kg: PA.4 BIAD
• Men: [(height in inches – 60) x 2.3] + 50 PA.5 Failed Airway
• Women: [(height in inches – 60) x 2.3] + 45.5. PA.4 Nasopharyngeal Airway
 Tidal Volume should not be altered to fix PA.7 Rapid Sequence Intubation
PA.7a Pre-intubation Checklist
ventilation, adjust rate instead for increased or
decreased minute volumes! Vt only gets changed for PA.8 Cricothyroidotomy
lung protection (i.e. to prevent barotrauma/volutrauma) PA.9 Needle Cricothyroidotomy
 Reduce VT by 1ml/kg at intervals ≤ 2hr until VT = 6cc/kg
PBW
 SEE PBW Tidal Volume Chart Below
• Rate (RR): Initially 14, adjust based on CO 2 (If CO 2 >45mmHg) and ventilatory needs (10-30)
• I:E: 1:2 (Patients with obstructive lung diseases should have increased I:E around 1:4 or 1:5; If rate >20 (most children) will
need to titrate iTime down to achieve appropriate I:E ratio)
• FiO2/PEEP (Should be adjusted in concert per the chart below)
o Start at 100% (1.0) FiO 2 and PEEP of 5; PEEP no higher than 16 on Pediatrics w/out expert consult
o Wait 5 minutes and assess SpO 2

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