Ventilator settings for dummies

[Chip N Sawbones]

Hi everyone,
I'm a med student currently working at a one room clinic on a very remote island in Alaska. The clinic recently acquired a ventilator, and I've been tasked with setting it up and writing a set of simplified instructions for its use. Any patient in respiratory failure will be flown to a real hospital three hours away, so the goal here is just to keep them alive until the medevac flight arrives. The clinic is generally staffed by a PA, NP or family medicine doctor and a tech or two, none of whom have much if any experience managing vent settings. Therefore, I'd like to provide them with a default set of vent settings that they can use on a patient presenting with respiratory failure until they can figure out something better. If a patient needs the ventilator then the healthcare provider will be on the phone with an intensivist or anesthesiologist who will be able to guide them in properly adjusting the ventilator, assuming the phones are working that day. Any settings you give should only be necessary for the first few minutes the patient is on the vent. I'm well aware that any guidelines you give will be rough. This is "bush medicine," where you make do with what you have.

I'm looking for suggested values for
Pressure triggering sensitivity (<Pbase):
PEEP/CPAP:
Pressure support (>Pbase):
Frequency:
Inspiratory time:
Volume or pressure control?
Volume:
Mode: (Assist/Control Mandatory Ventilation or Synchronized Intermittent Mandatory Ventilation or Spontaneous Ventilation)

So far my plan is
Pressure triggering sensitivity (<Pbase): 2.1
PEEP/CPAP: 5 cm H2O
Pressure support (>Pbase): 0
Frequency: 16 PBM
Inspiratory time: 1.0 sec
Volume control, 8 mL/kg estimated patient weight
Mode: Assist/Control Mandatory Ventilation
Supplemental O2 to meet oxygenation goals

Did I keep the patient alive? Any improvements you can suggest would be greatly appreciated. Should I have a separate list of settings for peds patients?
Thank you.

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[vector2]

Sorry, but why in god's name are you, the med student, tasked with setting up the ventilator and creating guidelines? I understand this is wilderness medicine and all, but vent setups (especially the first one in a facility) should involve a discussion between your attending physician, an intensivist, a respiratory therapist, and a rep from the company that manufactures the vent. This is especially true if no one in the building has any idea what they're doing.

 

[Chip N Sawbones]

Sorry, but why in god's name are you, the med student, tasked with setting up the ventilator and creating guidelines? I understand this is wilderness medicine and all, but vent setups (especially the first one in a facility) should involve a discussion between your attending physician, an intensivist, a respiratory therapist, and a rep from the company that manufactures the vent. This is especially true if no one in the building has any idea what they're doing.

You're absolutely right. Actually I'm not even working here as a med student; my wife is working in the clinic and I came up on vacation to visit her. I'm good with machinery, which makes me the most qualified vent tech in the clinic. The vent in question is a fairly simple model designed for home or clinic use. There's no way an attending physician, a respiratory therapist, or a company rep are going to fly in on one of the two flights a week to pay us a visit. If we end up with a patient in respiratory failure, they either will be plugged into the vent or they won't. If they do get plugged in, it would be nice to have the vent set to something that probably won't kill them until someone can figure out something better.

 

[pgg]

This is the weirdest medical advice thread ever.

But it's still a medical advice thread. We can't prescribe vent settings for an unknown future patient (a real one!) over the internet.

Closing.