ABG Vent Settings

Normally Vt settings are 6-8ml/kg ideal body weight

Must turn Lbs into Kg: Lbs 2.2 = Kg

1. Verify Vt, is that Vt correct setting for that pt. Must have height and gender, or weight to
calculate Vt.
RR: 8-12
Vt: Ideal body weight
FiO2: 40% or 100% if the pt is cyanotic.
PEEP: +5 unless pt is hypotensive then no PEEP
PS: 5-10
Mode: only spontaneous modes not CMV, Bi-vent, CPAP
Things you need to know about Interrupting ABGs

If CO2 is in the normal range then pt is ventilating.

Monitor mean airway pressure (MAP), static compliance, saturation, vitals, breathe sounds,
CXR.
Review pt medications and 1:0 ratio ( hypo or hypervolemic)
Ventilate in increments of 50ml ex. If Vt: 423 then you would use 400.
Decrease RR and CO2 is going to go up and pH is going to go up.
In a head injury you want to hyperventilate for 24-48 hours.
PCO2 is ventilation
PO2 is oxygenation or perfusion
If you decrease Vt, increase RR

PaO2
FiO2
PEEP

PaCO2
VT
RR

Ex. 80 kg person, VT: 550, RR: 10, FiO2: 45%, PEEP: +5

ABG: pH: 7.41 CO2:39 PO2: 49 HCO3: 24
1st Thing you do is check the tidal volume, what is the high and low Vt? ___________________
2nd Check ABG see if pt is ventilating, is pt ventilating if yes/no how do you know?
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3rd Check ABG see if pt is oxygenating, is pt oxygenating if yes/no how do you
know?_______________________________________________________________________

4th How do you fix the problem?

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Ex 100 kg male, with moderate sever RDS. Mode: SIMV, VT: 750, RR: 6, FiO2: 35%,
PEEP: +7, PS: 5.

ABG: pH: 7.39

CO2: 57 HCO3: 34 PO2: 74

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Ex. Male Head injury, male pt that is on AC=14/600/.60.0

ABG: pH: 7.30 PO2: 256 CO2: 29 HCO3: 13.9
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Ex. 167 lb male, with smoke inhalation on SIMV=20/600/100/20

ABG: pH: 7.29 CO2: 41 PO2: 155 HCO3: 19.4 CHBCO: 21.2% HB: 14

Normal range is 0-3% or 3% in a smoker

Smoke inhalation gets 100% FiO2

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Permissive Hypercapnia

RT will let pH go as low as 7.1

Must keep sat. 85 or higher
ARDS and status asthmatics

Contraindications

Any type of intracranial lesion

Relative Contraindications

Hemodynamic instability

Altersions

Increase cardiac output

Normal SBP, Systolic Blood Pressure
Pulmonary Hypertension

Use with caution in pt with cardiac ischemia, pre-existing pulmonary hypertension, left vent.
failure, and right heart failure.

Bi-vent
Initial Settings

P High
Plateau Pressure

T High
4-5.5 sec (range is 4-6 sec)

P Low
Pressure is 0 Because P Low is PEEP

T PEEP Low
Time Constant

Cant use an HME because of low Vt

Things that can increase Paw

Peep
PIP
I:E
Insp. Time
Paw increases PaO2

Indications for Bi-Vent

Pt who is at risk of ALI/ARDS

Pt with poor rib expansion
Pt who has a PF ratio of less than 300
Pt doing poorly on another vent mode with a rate greater than 25
Pt that is very tachypneic but is unable to be sedated because of low BP
Pt on a 60/10 rule ( 60% / 10 cmH20 PEEP)