key: cord-0788445-q46gkzt6
authors: Acho, Megan; Lee, Alyson C.; Lee, Burton W.
title: Ventilators for Nonintensivists. Reasonable Initial Ventilator Settings for Patients with Acute Respiratory Distress Syndrome
date: 2020-05-19
journal: ATS scholar
DOI: 10.34197/ats-scholar.2020-0052vo
sha: 1af6b0c5f49dab87b8f9c94f4cc0daeb6a72c95c
doc_id: 788445
cord_uid: q46gkzt6

nan

As coronavirus disease has rapidly evolved into a pandemic, many physicians without prior critical care training are being called upon to help manage severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)infected patients who develop respiratory failure and require mechanical ventilation. This video is intended to provide a brief and simplified approach to mechanical ventilation for nonintensivists with an overview of recommended initial ventilator settings for patients with acute respiratory distress syndrome (ARDS). ARDS is defined as an acute insult resulting in bilateral pulmonary opacities, not fully explained by effusions, atelectasis, nodules, or heart failure, and hypoxemia defined as a Pa O 2 to FI O 2 ratio <300. ARDS patients are frequently intubated in the setting of hypoxia, hypercarbia, or increased work of breathing. For acutely ill patients, the most commonly used mode is the assist control mode. The assist control mode requires the clinician to set the FI O 2 , positive end-expiratory pressure (PEEP), respiratory rate, breath type (most commonly either volume control [VC] or pressure control [PC]), and either inspiratory time or flow rate. Whether the clinician uses VC or PC, it is important that the set tidal volume (VT) in case of VC or the resulting VT in case of PC is 4-8 ml/kg of predicted body weight. Reasonable initial settings are 100% FI O 2 , PEEP of ≥5 cm H 2 O, respiratory rate of 20, and VT or PC to achieve 6 ml/kg of Video 1. Reasonable initial ventilator settings for patients with acute respiratory distress syndrome. predicted body weight. Reasonable inspiratory flow rates for patients on VC are 60-80 L/min in decelerating ramp flow pattern or 30-40 L/min in square wave flow pattern. Reasonable initial inspiratory time for PC is 0.6-1 second.

Author disclosures are available with the text of this article at www.atsjournals.org.

ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin definition

Acute respiratory distress syndrome: advances in diagnosis and treatment

Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome

Essentials of mechanical ventilation

Ventilators for nonintensivists: basic ventilator parameters

Ventilators for nonintensivists: basic modes and breath types