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{{Adult top}} [[initial mechanical ventilation settings (peds)]].''
==Overview==
{{Initial ventilation settings table}}

==Traditional==
*FiO2 100% (1.0) and ween down 
*Rate 8-12/min
**consider 5-6 for asthma with permissive hypercapnea
*[[Ventilation (Main)|Mode]] 
**A/C = default (most) 
**SIMV = with obstructive airway disease and an intact respiratory effort (e.g. some [[COPD]], [[asthma]]) 
**PC = with intact respiratory effort and non-severe respiratory failure (prefered in chronic vent) 
*PEEP 0-5 mmH20 
*Tidal volume: 5-8 cc/kg (eg. 500-600cc) 
**(adjust to plateau pressure <35 cmH20) 
*I/E 1:2 
*Pressure support: 5-8cm to overcome endotracheal tube

==Lung Protective Strategy==
===Background===
*Focuses on low-tidal volume ventilation to reduce ventilator-associated lung injury (e.g. barotrauma and volutrauma worsening/causing [[ARDS]])<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref>
*Indicated for all intubated patients who do not have obstructive lung disease ([[COPD]], [[asthma]])<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref>

{{Lung Protective Ventilator Settings}}
{{Lung Protective FiO2 and PEEP Scale}}

==Obstruction Strategy==
===Background===
*For patients with active bronchoconstriction (e.g. [[COPD]], [[asthma]])
*The best ventilatory strategy for these patients is to avoid intubation if possible; mechanical ventilation will often make the pulmonary situation worse, rather than better.<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref>
*Goal = adequate time for expiration
*Frequently requires deep sedation and analgesia (first-line); may required paralysis (second-line)<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref>

===Settings===
#Mode
#*Volume-assist control
#Tidal Volume
#*Vt = 6-8 cc/kg of [[Ideal body weight|Ideal Body Weight]]
#**Ideal Body Weight used because lung parenchyma does not increase in size as the person gains more weight
#Inspiratory Flow Rate
#*60-80 L/minute
#**Some advocate for higher rates (e.g. 80-100 LPM) to allow more expiration time, however this will increase the peak pressures and has not shown to produce any clinically meaningful change in the expiration time<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref><ref>Leatherman JW, McArthur C, Shapiro RS. Effect of prolongation of expiratory time on dynamic hyperinflation in mechanically ventilated patients with severe asthma. Crit Care Med. 2004;32:1542-1545.</ref>
#FiO2/PEEP
#*Titrate FiO2 to desired SpO2
#*Set PEEP 0-5
#Respiratory Rate
#*Set low - 10 BPM
#*Adjust for I:E 1:4 or 1:5
#*Permissive hypercapnia to avoid breath stacking
#**Ok as long as pH > 7.00-7.10
#**Maintain plateau pressure <30<ref>20. Oddo M, Feihl F, Schaller MD, Perret C. Management of mechanical ventilation in acute severe asthma: practical aspects. Intensive Care Med. 2006; 32(4):501-510.</ref>
#***If >30 go down on rate

==Hypovolemic==
*Consider reducing PEEP to maintain adequate preload and prevent/minimize hypotension

==Miscellaneous==
''Normally already set''
*Inspiratory flow rate = 60L/min<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref> (100 L/min with asthma) 
*Sensitivity = 1-2 cmH2O

==See Also==
{{Mechanical ventilation pages}}
*[[Ideal_body_weight_estimation|Ideal Body Weight Estimation]]
==References==
<references/>

[[Category:Critical Care]] 
[[Category:Pulmonary]]