Cheat Sheet 1

Respiratory Therapy Cave Respiratorytherapycave.blogspot.com Mechanical Ventilator Guidelines and Calculators

Ideal Tidal Volume for Women (Based on 6-10ml/kg IBW) Height Kg Min Max VT VT 5’0” 50 300 500 5’1” 52.5 315 525 5’2” 55 330 550 5’3” 57.5 345 575 5’4” 60 360 600 5’5” 62.5 375 625 5’6” 65 390 650 5’7” 67.5 405 675 5’8” 70 420 700 5’9” 72.5 435 725 5’10” 75 450 750 5’11” 77.5 465 775 6’0” 80 480 800 6’1” 82.5 495 825 6’2” 85 510 850 6’3” 87.5 525 875 6’4” 90 540 900 6’5” 92.5 555 925 6’6” 95 570 950 6’7” 97.5 585 975 6’8” 100 605 1000 6’9” 102. 620 1025 5 6’10” 105 635 1050 6’11” 107. 650 1075 5

Ideal Tidal Volume for Men (Based on 6-10ml/kg IBW) Height Kg Min Max VT VT 5’0” 53 318 530 5’1” 56 336 560 5’2” 59 354 590 5’3” 62 372 620 5’4” 65 390 650 5’5” 68 408 680 5’6” 72 426 710 5’7” 75 444 740 5’8” 78 462 770 5’9” 81 480 800 5’10” 84 498 830 5’11” 87 516 860 6’0” 90 534 890 6’1” 93 552 920 6’2” 96 570 950 6’3” 99 588 980 6’4” 103 606 1010 6’5” 106 624 1040 6’6” 109 642 1070 6’7” 112 660 1100 6’8” 115 678 1130 6’9” 118 696 1160 6’10” 121 714 1190 6’11” 124 732 1220 7’0” 127 750 1250

Initial Vent settings per protocol: 1. FIO2: 40% (PO2 >92%) 2. VT: 6-10 ml/kg IBW (for acute lung injury use 6 ml/kg IBW) 3. PRVC: 10-14 BPM 4. PEEP: 5 5. ABG 30 minutes post set-up 6. Automode: per RT discretion 7. Maintain cuff pressure >20 8. Suction and send sputum to lab 9. Perform oral care Q2 hours 10.Elevate HOB 40 degrees

Stop wean or spontaneous mode if: 1. Change in BP >20 2. SpO2<92% or as specified by Dr. 3. RR over 30>5 minutes 4. VT <5ml/kg IBW 5. HR >20% above baseline 6. Pt. apneic, anxious, diaphoretic, or other indications of stress. Optimal Peep: Increase PEEP by 2-3 Q20 minutes. If static compliance, P/F Ratio &/or SpO2 go up, it’s working. Stop when P/F Ratio = >200, or when static compliance decreases, P/F Ratio decreases or BP decreases. Do not increase PEEP if systolic BP <90. Also keep MAP <15, as it usually drops before cardiac output. Ideally, Static Compliance should be between 60-100

Considerations for readiness to wean patient from ventilator: 1. Awake and alert. 13. A-a gradient < 300 2. Able to follow commands 14. a-A ratio > 50% or PaO2/FiO2 >150 – 200 3. Spontaneously breathing 15. Underlying condition resolved 4. Adequate cough 16. Secretions thin and minimal 5. Pain controlled 17. Chest X-Ray improving 6. No obvious signs of respiratory distress 18. Adequately nourished (Albumin >2.5) 7. Little to no anxiety 19. Electrolytes stable (CA, Mg, K) 8. FIO2 =< 40 and PEEP =<5 20. Adequate hemoglobin (>8-10g/dl) & Hct (>25% or baseline) 9 TEMP < 100.4 (no seizures, sepsis) 21. Absence of bowel problems (Diarrhea, constipation, ileus)? 10. Hemodynamically stable: 22. Weaning parameters within normal limits a. Systolic BP > 90 mmHg a. NIF > 20 b. VC >10ml/kg IBW (2*VT) b. Pulse >50 < 120 c. VE < 10 d. VT > 5ml/kg IBW c. No Dopamine infusion > 5 mcg/kg d. RR < 30 e. RSBI < 100 (VT/RR) 11. SPO2 > 90% or normal for patient 23. PS pt using in automode must be at pt weaning level. 12. ABGs normal for patient a. PS = Plateau (Static) Pressure - PEEP 13. P.01 <4.2 (calculated in spont. Mode) b. Normal PS usually at least < or = 10