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Table 3.10

Simple Rules For Ventilator Management

Low PO2 (oxygenation issue)
  • Consider ventilator malfunction or circuit disconnection, or patient issues such as depth of anesthesia or pneumothorax
  • Increase FiO2 while patient is being assessed and other solutions are sought
  • Make small increases in PEEP in stepwise fashion
  • Sometimes an adjustment in I:E ratio is helpful
  • Often necessary to increase the PIP to compensate for a patient's abnormal pulmonary compliance
High PCO2 (ventilation issue)
  • Consider ventilator malfunction or patient issues such as endotracheal tube obstruction, excessive dead space or pneumothorax
  • Increase minute ventilation by increasing tidal volume and/or respiratory rate
  • Suction
  • Bronchodilators
High Peak Pressures and High Plateau Pressure (non compliant lungs)
May be caused by:
  • ARDS
  • Pulmonary edema
  • Atelectasis
  • Tension pneumothorax
  • Decreased chest wall compliance
  • Worsening consolidation
  • Mainstem intubation
High Peak Pressure and Low/Normal Plateau Pressure (airway problem)
May be caused by:
  • Bronchospasm
  • Patient biting tube
  • Mucus plug
  • Secretion
  • Obstructed tubing
Low Peak Pressure and Low Plateau Pressure (disconnect problem)
May be caused by:
  • Consider disconnected tube
  • Lost airway