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Vent Settings - Normal range of:

minute ventilation (VE)
5-7 L/min
Vent Settings - Normal range of:

respiratory rate (f)
6-20 breaths/min
Vent Settings - Normal range of:

tidal volume (VT)
5-12 mL/kg (Table 11-3)

alt: 7-9 mL/kg or 500-800 mL (adult)
Vent Settings - Normal range of:

fraction of inspired oxygen (FiO2)
0.21-1.0

expressed as % of oxygen concentration inspired (max 1.0 or 100%)
Vent Settings - Normal range of:

positive end expiratory pressure (PEEP)
5-20 cm H20
Vent Settings - Normal range of:

pressure support (PS)
5-15 cm H20
Vent Settings - Normal range of:

peak pressure (Ppeak) or peak inspiratory pressure (PIP)
< 40 cm H20
What is tidal volume (Vt or TV)?
the amount of air that moves in and out of the lungs in one normal breath. It is also an important setting on a mechanical ventilator - if set too high the patient is hyperventilated (risk for pneumothorax), if set too low the patient is hypoventilated.
• Amount of air that moves in/out of lungs in one normal breath
• Goal: keep peak airway pressure while maintaining adequate ventilation
What is FiO2?
fraction of inspired oxygen - that portion of the total gas being inspired that is composed of oxygen; expressed in decimals from 0.21 to 1.0.
• Expressed as decimal, but discussed in % in terms of O2 concentrations
What is respiratory rate (f)?
properly setting the respiratory (breathing) rate (f) on the ventilator is important in establishing adequate minute ventilation (VE). Minute ventilation is the amount of air that moves in and out of the lungs in one minute.
What is PEEP?
the application of positive pressure to the airway at the end of expiration such that the airway pressure never returns to ambient.
What is Ppeak or PIP?
Peak Airway Pressure (PPEAK) or Peak Inspiratory Pressure (PIP)

- amount of pressure required to deliver a volume of gas. PIP levels < 40 cm H20 are considered desirable. High PIPs greatly increase risk of barotraumas & have negative effects on other body systems.
What is PS or PSV?
Pressure Support (PS) or Pressure Support Ventilation (PSV)

- type of mechanical ventilatory support in which a preset level of positive pressure augments the inspiratory effort required to attain a tidal volume, thereby decreasing the work of breathing.
What is positive pressure ventilation
(the mainstay of ventilator support in acute care settings): Most commonly require an artificial airway to deliver ventilator support. Gases are driven into the lungs through the ventilator’s circuitry, which is attached to an artificial airway (ET or tracheostomy tube).
Positive pressure ventilation:

Describe pressure cycled vent
Pressure-cycled ventilation delivers a preset pressure of gas to the lungs.
The pressure delivered (expressed in cm H2O) is constant while the volume of air it delivers varies with the lungs compliance and airway resistance.

Pressure-cycled ventilation is increasingly used as a method to protect the injured lung from further damage from high pressures and is an option on most ventilators.
Positive pressure ventilation:

Describe volume cycled vent
Volume-cycled ventilation delivers a preset volume of gas (measured in mL or L) to the lungs, making volume the constant and pressure the variable.
Within a certain preset safety range (pressure limits), the ventilator will deliver the established volume of gas regardless of the amount of pressure it requires. This has the advantage of being able to overcome changes in lung compliance and airway resistance.
E.g. as lung compliance decreases or airway resistance increases, the pressure at which the gas is delivered to the lungs will increase sufficiently to deliver the desired volume of gas to the lungs.

**potential to generate high pressures, especially in less compliant lungs in order to deliver the set volume. Therefore, the risk of barotraumas is greater.
Positive pressure ventilation:

Describe time cycled vent
When time-cycled ventilation is used, the length of time allowed for inspiration is controlled. These ventilators hold time constant but volume and pressure may vary.
Time-cycled ventilators frequently are referred to as time-cycled-pressure-limited ventilators b/c they also limit the maximum amount of pressure that can be delivered.
The microprocessor ventilators can use time cycling and also have the advantage of being able to limit volume and pressure.
Positive pressure ventilation:

Describe flow cycled vent
Pressure support ventilation (PSV) is an example of flow-cycled ventilation. A preset pressure augments the Pt’s inspiratory effort and continues as long as the Pt continues to inhale at a certain flow rate. As the Pt reaches the end of inspiration, flow decreases. At a predetermined level of flow (e.g, 25% of peak inspiratory flow) inspiration ends.

Tidal volume (VT), rate, and time are variable.
Ventilator modes:

Assisted-Control (AC) +/-?
(+): Every breath is guaranteed set TV.
Takes over work of breathing, respiratory muscle rest

(-): Risk of hyperventilation. Respiratory muscle atrophy
Ventilator modes:

Synchronized Intermittent Mandatory Ventilation (SIMV) +/-?
(+): Prevents respiratory muscle atrophy.
Decreased risk of hyperventilation.
Better vent-perfusion distribution

(-): Tachypnea & fatigue if set rate too low
Ventilator modes:

Pressure Support Ventilation (PSV) +/-?
(+): Improved pt-ventilator sychrony.
Prevents respiratory muscle atrophy.
Facilitates weaning

(-): Requires spontaneous respiratory effort.
Tachypnea & fatigue if pressure support is too low.
Ventilator modes:

Pressure-Regulated Volume-Controlled Ventilation (PRVC) +/-?
(+): Guaranteed VE.
Improved pt-ventilator synchrony.
Decreased risk of barotrauma.

(-): Respiratory muscle atrophy.
May result in unequal vent-perfusion distribution
Which of the following is a FALSE statement about aspirin administration?

A. It should be given within 24 hours of thrombolytic therapy.
B. It should not be given within 24 hours of thrombolytic therapy.
C. It should not be used as a substitute for rtPA.
D. Less is known about the use of aspirin with cerebral ischemia.
A. It should be given within 24 hours of thrombolytic therapy.

Rationale: The administration of aspirin as an adjunct therapy within 24 hours of the use of thrombolytic agents is NOT recommended. No recommendation can be made about the urgent administration of other antiplatelet aggregating agents.
Central Venous Pressure (CVP) or RAP (Right Atrial Pressure)

normal value?
1-8 mm Hg (says ATI)
2-6 mm Hg (says Wagner txt)
Pulmonary Artery Systolic (PAS)

normal value?
15-26 mm Hg (says ATI)

20-30 mm Hg (says Wagner txt)
Pulmonary Artery Diastolic (PAD)

normal value?
5-15 mm Hg (says ATI)

8-15 mm Hg (2 to 5 mm Hg higher than PAWP) (says Wagner txt)
Pulmonary Artery Wedge Pressure (PAWP)

normal value?
4-12 mm Hg
Cardiac Output (CO)

normal value?
4-6 L/min (says ATI)

4-8 L/min (says Wagner txt)
Mixed venous oxygen saturation (SvO2)

normal value?
60-80%
Hemodynamic parameters:

CI = CO/BSA
2.4-4.0 L/min/m2
Hemodynamic parameters:

LVSWI = [(MAP - PAWP) x (SVI) x (0.0136)]
50-62 g/m^2/beat
Hemodynamic parameters:

MAP = [(SBP) + 2 (DBP)]/3
12-20 mm Hg
Hemodynamic parameters:

PVR = [(Mean PAP) - (PAWP) x 80]/CO
50-250 dynes*sec*cm^-5
Hemodynamic parameters:

PVRI = [(Mean PAP) - (PAWP) x 80]/CI
255-315 dynes*sec*cm^-5/m^2
Hemodynamic parameters:

RV pressures (RV systolic/RV diastolic)
RV systolic: 20-30 mmHg / ...
RV diastolic: 2-8 mm Hg
Hemodynamic parameters:

RVSWI = [(Mean PAP - RAP) x (SVI) x (0.0136)]
7.9-9.7 g/m^2/beat
Hemodynamic parameters:

SVI = CI/HR
25-45 mL/beat/m^2
Hemodynamic parameters:

SV = CO/HR
50-100 mL/beat
Hemodynamic parameters:

SVR = [(MAP) - (RAP) x 80]/CO
800-1200 dynes*sec*cm^-5
Hemodynamic parameters:

SVRI = [(MAP) - (RAP) x 80]/CI
1,970-2,390 dynes*sec*cm^-5/m^2