Vent settings and documentation

Where I work there is four settings we document: the tidal volume (which is IDEAL weight based--8ccs per kg) the respiratory rate (important to know, as to tell whether or not the pt is overbreathing the vent or not), the PEEP (which is almost always 5, unless the pt has ARDS or other serious lung disease) and the FIO2 (which is set anywhere from 30-100%). If the pt was just emergently intubated, it would probably be at 100%.

I would bet that you would have a standard vent protocol that would give you the standards for your facility.

hmm. i will have to look for the protocol..

can you elaborate on overbreathing?

thanks!!!!

liz

I don't know anything about norms for big people...

You'll be looking for the MODE: common modes include SIMV/PCPS (synchronized intermittent mandatory ventilation / pressure control pressure support), SIMV/VC (volume control), SIMV/PRVC (pressure regulated volume control). We always put our kiddos in SIMV because the vent works with them instead of against (hopefully) ... not sure if it's a different world for grownups. Hopefully someone can jump in with modes for adults?

IMV or RATE: We call it the IMV (from the SIMV above), and it's the number of breaths at the specified settings that the vent will deliver in a minute.

PEEP: positive end-expiratory pressure. Common in kiddos is +5 or +6, but I've seen up to +16 on an 18-year old I picked up once. (can anyone say pneumo?!) We usually consider the ocsillator once they're up at +10 and not ventilating too well.

FiO2: percentage of inspired oxygen. Expressed either as a percent (50%) or as a decimal (0.50)

Other settings will become important depending on what type of mode you're in.

If you're in a VC mode, you'll have a preset TIDAL VOLUME (TV) (with the kiddos, we expect this to be around 8-12 ml/kg). The vent will deliver that amount of volume for each breath at the set rate. You want to watch your PEAK INSPIRATORY PRESSURES (PIPs) with VC ventilation, because if those pressures start to climb, it's a marker that the lungs are becoming stiffer and you run the risk of damaging them by forcing in volume. In that case, you might want to switch to a pressure regulated mode.

If you're in a PC mode, expect to see PRESSURE CONTROL (PC) and PRESSURE SUPPORT (PS) settings. The vent will deliver a breath until it hits a preset pressure (the PC number) and then let the patient exhale. On breaths the patient initiates, it will support them with the amount specified in the PS number. (I'm typing this and feeling unsure of myself ... please correct me if I'm wrong.) In a PC mode, watch your tidal volumes as a measure of lung compliance ... with nice, soft lungs, you should be getting those 8-12 ml/kg of volume. As those numbers start to fall, you're looking at worsening compliance.

Example:

4 month old baby weighs 10 kg. Their vent settings might look something like this:

MODE: SIMV/PCPS

FiO2: 0.35

IMV: 16

PC: 12

PS: 8

PEEP: +5

With this patient, all those settings will remain constant, and the tidal volumes will be the dynamic number I'm looking at to determine whether my kid is getting better or worse. Hopefully he's pulling volumes around 90-100 ml. (In a perfect world...)

(Holy cow, that got long.)

If the patient is overbreathing the vent that can be a good sign in that they are able to deliver their own breaths and have the strength to do so, however if they are not well-sedated and the idea is for them to rest on the vent, then overbreathing can indicate that more sedation is needed.

We document mode (alalways Assist Control), resp rate, tidal volume, O2% (almost always starts at 100%,) and PEEP.

By the way, "over breathing" means the patient is breathing faster than the vent-this can be good or bad-pt may be more alert, or could be resp distress, anxiety, pain, drugs, etc.

Wow alirae, not bad for a nurse! LOL! Just kidding Lizzie, next time just grab the RT and ask. Part of our job is to make it clear to you guys whats going on with the vent.

Hi.

Im a newish grad who is now working in the ED. I had a vent patient the other day and the RT told me the settings very quickly for me to document. I am just wondering what settings should I be expecting to document? what are the norms for these settings? I just want to have a heads up for next time in case something is missing..

Thanks!!!

In my ER, RTs do their own documentation in the puter. I just Vent settings per RT.

K.I.S.S.

Wow alirae, not bad for a nurse! LOL!

I'm headed to Sierra Leone next year where I can expect to manage PICU patients without the help of an RT or an intensivist, so I've been taking my time to try and learn! (Plus I do a ton of preceptping, and there isn't always an RT available when my little ducklings have a question). But thanks!