as respiratory therapists we spend a lot of time focusing on mechanical ventilators
we often learn about the different modes settings and how they function with that said unfortunately
we often overlook the process that entails the initiation of a new patient who needs mechanical
ventilatory support when setting up a patient on the ventilator you must understand the indications
contraindications and initial settings to use each of which may be different depending on
the patient's condition we created this quick video to hopefully make the learning process
easier for you while providing a brief overview of this topic so if you're ready let's get into it
first and foremost we need to talk about the goals of mechanical ventilation a mechanical ventilator
in and of itself does not cure a patient of their initial underlying condition the ventilator is
only meant to provide breathing support until the patient's condition can be treated and reversed
with that said here are the primary goals of mechanical ventilation to improve gas exchange
to reverse hypoxemia to reverse acute respiratory failure to provide relief for respiratory distress
to reverse respiratory muscle fatigue to improve pulmonary mechanics
to prevent or reverse atelectasis to improve lung compliance to prevent lung injury to maintain
lung and airway functionality and to prevent respiratory muscular dystrophy again the goals
of mechanical ventilation will be different for each and every patient these are just a
few of the most common examples now let's talk about the indications for mechanical ventilation
as a general rule of thumb mechanical ventilation is indicated whenever a patient's spontaneous
breathing is not adequate enough to sustain life in such a case a mechanical ventilator
would be needed in order to support the patient until their underlying condition is reversed
here are some of the common indications for mechanical ventilation that you should know
insufficient oxygenation insufficient ventilation and acute lung injury severe asthma
severe hypotension and the inability to protect the airway
we've broken down each of these indications deeper into much more detail in separate videos
so definitely be sure to subscribe if you haven't done so already but now we need to talk about the
contraindications when would you not want to use mechanical ventilation in general a patient
cannot survive without adequate ventilation and oxygenation this means that there are no absolute
contraindications for mechanical ventilatory support because if a patient needs help breathing
and requires full ventilatory support they are likely going to need mechanical ventilation
there really is no way around it the only contraindication for mechanical ventilation
is if the patient legally and specifically states that they do not wish to be intubated or receive
life support this is referred to as a dni order or do not intubate in such a case the patient may
receive bi-level positive airway pressure instead as a form of non-invasive ventilation moving right
along now we need to talk about the initial ventilator settings once it has been determined
that mechanical ventilation is indicated you must know how to properly input the initial settings
each mechanical ventilator machine is different so it's important to abide by the guidelines
provided by the manufacturer of each type of machine however here are some general
guidelines that you can use when determining a patient's initial ventilator settings first you
will need to select the mode you should know that any operational mode will work when setting up the
initial ventilator settings it's important not to get too caught up on deciding the right mode
this is especially true for the tmc exam what's important is providing ventilation and oxygenation
for the patient which can be done using the other settings that we are about to discuss
the mode can be changed at any time once support has been initiated
with that said just as a reminder you can select assist control if the patient needs full support
or simv if they only need partial support then you will need to input the initial title volume
the initial title volume setting should be 5 to 10 milliliters per kilogram of the patient's
ideal body weight so if you know the patient's ideal body weight then you can easily calculate
the initial tidal volume setting on the ventilator now i realize that many of you guys were probably
taught to use six to eight milliliters per kilogram as the range for the initial tidal volume
yes that one technically is correct as well and is actually even more precise but through
my experience using five to ten milliliters per kilogram will still help you come up with the
correct answer and it makes the calculation much easier because you can quickly do it in
your head but like i said it's up to you you can use whichever one you feel more comfortable with
then you need to input the frequency the initial frequency setting should be 10
to 20 breaths per minute next is the fio2 the initial fio2 setting should be 30 to 60
unless the patient was previously receiving a higher percentage of oxygen before intubation
if that's the case then you would simply use that previous fio2 for example if a patient in
the emergency department was receiving 100 oxygen via a non-rebreathing mask once they're intubated
initially you would set them up with an fil2 of 100 and then titrate them down from there
otherwise if a new patient was not receiving oxygen this is when you should stay within the
30 to 60 range keep in mind that in general you should strive to provide the lowest concentration
of oxygen that's possible in order to maintain a normal pao2 as i mentioned an fio2 up to 100
as an initial setting is appropriate for patients with severe oxygenation issues
just keep in mind that you'll want to try to titrate and wean them down below 60 as soon
as possible next up is the flow rate the initial flow setting should be 40 to 60 liters per minute
then there is the ie ratio the initial ie ratio setting should be one to two to one to four
the initial sensitivity setting should be between negative one and negative 2 centimeters of water
pressure and finally we have the peak the initial peep setting should be 4 to 6 centimeters of water
pressure again in order to fully understand the initiation of mechanical ventilation
it's extremely important to learn about the initial settings to use
when first setting up a new patient on the ventilator real quick guys do me a huge favor
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ton of other videos on our channel that i think you will enjoy just a quick reminder we are not
doctors this video is for educational and informational purposes only and if you want
to dive deeper and learn more about this topic you can go to respiratorytherapyzone.com where
we have a ton of free study guides practice questions and other helpful resources
i'll drop links to everything you need right below this video down in the description thank you so
much for watching all the way to the end have a blessed day and as always real easy my friends
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