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Description For the purpose of this section a mechanical ventilator is used to support patients who need mechanical, assisted or spontaneous ventilation while intubated. This procedure describes the general set up, use and discontinuation for all ventilators. There are individual procedures for each ventilator that include a description of the modes available for the ventilator, performance data, and important operational information. For specific information regarding the operation of any ventilator, users should consult the operation manuals available in the Respiratory Care department.

Equipment •

Mechanical Ventilator

•

Patient ventilator circuit

•

Humidifier

•

Bedside Resuscitator o Adults: §

At PEEP < 10 cm H2O: 3L modified Jackson Reese (flow inflating bag) with mask and flow-meter.

§

At PEEP > 10 cm H2O: Self inflating resuscitator with PEEP valve set to patient's PEEP level.

o Pediatric: 1L modified Jackson Reese with mask and flow-meter. o Infant: Use the neonatal hyperinflation bag

Physician Orders / House Formula Every ventilator set up must have a physician order stating the need for it. Preprinted initial Ventilator Orders are used in the Critical Care Units. House formula is as follows: Adults 1. Use volume control ventilation with tidal volume – 6-8 ml/kg. 2. FIO2 - begin at 0.9 and decrease to maintain PaO2 between 65 and 100 torr. 3. Backup ventilation rate - 10 breaths/min. 4. PEEP (if ordered) - begin at 5 cm H2O. RCS SFGH Reviewed 1/02, 7/09, 11/10, 6/12 Adopted: 3/99

Revised 8/04, 10/07, 7/09, 5/10, 6/11

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5. I:E Ratio – 1:3 Pediatrics 1. Use pressure control ventilation of 20 cm H2O 2. FIO2 - begin at 0.9 and decrease to maintain PaO2 between 65 and 100 torr. 3. Backup ventilation rate - 12 breaths/min 4. PEEP (if ordered) - begin at 5 cm H2O. Infants and Neonates - use time cycled, pressure limited ventilation. 1. Flow-rate: 8 L/min 2. Inspiratory time: 0.3 seconds 3. Expiratory time: 1.7 sec 4. Pressure: 20 cm H2O 5. Pressure Limit: 35 cm H2O 6. PEEP: 4 cm H2O Choice Of Ventilator Circuit Choice of ventilator circuit is dependent on the ventilator used and or the body weight of the patient. Body Weight

Circuit Draeger BabyLog

Draeger XL w/Neoflow

20 kg

Do not use

Do not use

Adult

Adult

RCS SFGH Reviewed 1/02, 7/09, 11/10, 6/12 Adopted: 3/99

Draeger Evita XL

Draeger Savina

Viasys Avea

Pulmonetics LTV 1000

VersaMed

Do not use

Do not use

Adult

Adult

Adult

Adult

Adult

Adult

Do not use Do not use Do not use

iVent 201

Revised 8/04, 10/07, 7/09, 5/10, 6/11

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Standing Orders In the ICU's, therapists have standing orders to monitor patient ventilation. If the Therapist feels a change in ventilation is appropriate, they must consult the responsible physician, get a written order, make the change, and notify the responsible nurse. Documentation of the rationale for any change must be charted on the patient's cardiopulmonary flow sheet. The following ventilator parameters may be adjusted by the therapist as needed. 1. Inspiratory flow 2. Inspiratory Time 3. Sensitivity 4. Peak pressure limit/pop off - (usually 10 to 25 cm H20 above peak pressure).

Alarms Alarms - All ventilators have monitoring alarms. The alarms should indicate pressure and volume variance from the norm or set values. The five most common alarms and their proper settings are: 1. High minute volume - usually set approximately 50% - 75% above patient's normal minute volume. 2. Low minute volume - usually set approximately 50% of normal patient or set minute volume, but in all cases above 0. 3. High-pressure relief alarm - set 25 cm H2O above peak inspiratory pressure. 4. Upper FIO2 - set