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Adjusting ventilator settings based on ABG?
Started by bulldog
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...might try the CCM forum
B
Blade28
It's very dependent on your institution and service's policies.
For example, at our county (trauma) hospital's SICU rotation, you can use the following GENERAL rules for SIMV:
(1) If PO2 > 80-100, can either wean FiO2 or PEEP (try FiO2 first, from 100% to 80, then 60, then 40; PEEP can be weaned by 1-2 daily)
(2) If PCO2 is adequate, can wean PS (by 1-2 daily)
(3) If patient overbreathing excessively, see if you can drop the RR
(4) Don't forget to follow the daily CXR
(5) If you want to be more aggressive, make some vent changes, wait a couple hours, check another ABG, then adjust again
(6) Don't forget to keep RT in the loop
We tend to try and wean to SIMV 40%, rate of 1, minimal PEEP and PS before considering extubation.
Don't forget being ready for extubation, and being ready to be separated from the vent, are two completely different (and sometimes mutually exclusive) things.
Now if you're talking conventional CMV/AC, or BiLEVEL/APRV (or any other new mode) then that's a whole 'nother story.
For example, at our county (trauma) hospital's SICU rotation, you can use the following GENERAL rules for SIMV:
(1) If PO2 > 80-100, can either wean FiO2 or PEEP (try FiO2 first, from 100% to 80, then 60, then 40; PEEP can be weaned by 1-2 daily)
(2) If PCO2 is adequate, can wean PS (by 1-2 daily)
(3) If patient overbreathing excessively, see if you can drop the RR
(4) Don't forget to follow the daily CXR
(5) If you want to be more aggressive, make some vent changes, wait a couple hours, check another ABG, then adjust again
(6) Don't forget to keep RT in the loop
We tend to try and wean to SIMV 40%, rate of 1, minimal PEEP and PS before considering extubation.
Don't forget being ready for extubation, and being ready to be separated from the vent, are two completely different (and sometimes mutually exclusive) things.
Now if you're talking conventional CMV/AC, or BiLEVEL/APRV (or any other new mode) then that's a whole 'nother story.
