The Rules of Mechanical Ventilation
The Rules of Mechanical Ventilation
Keith D. Lamb, RRT, RRT-ACCS, FAARC,
FCCM
Over the
last few years there have been many advances in technology that have been
implemented in critical care, especially as it pertains to mechanical
ventilation and the utilization of imaging to make clinical decisions.
The
universal teaching of newer modes of ventilation and of theories like the
equation of motion, and mechanical power has become standard, and many programs
have implemented these ideas in their curriculum, particularly in post graduate
programs, and critical care fellowships.
The above being
said, these advances have little or no evidence that they impact clinical
outcomes and are difficult for the average bedside clinician to understand and
effectively utilize in real time while taking care of critically ill or injured
patients. Many graduate from programs without understanding the basic tenants
of mechanical ventilation and how to implement them at the bedside.
There are
several approaches to the management of mechanical ventilation that do have
data and evidence to support positive effect on outcomes and are reasonably
easy to conceptualize and understand. I have reduced these concepts down to
what I call the “Rules of Mechanical Ventilation”. I list these rules here, and I have developed
short videos that are available that discuss these rules along with many other
topics that are being developed weekly. These videos are available on my
YouTube Channel. I call these videos RT CIMS, or RT Complex Issues Made Simple.
Please subscribe and follow.
Here are my
“Rules of Mechanical Ventilation”.
1) Initiate mechanical ventilation
utilizing tidal volumes between 4-8ml/kg/pbw. Then dose the ventilator to the
patient.
2) Keep plateau pressure less than 30
cmH2O
3) Keep driving pressure less than 15 cmH2O
4) Customize PEEP to prevent
atelectrauma, improve compliance, and to allow the use of the lowest FIO2
available.
5) Make the ventilator fit the patient
to prevent asynchrony. Do not make the patient fit the ventilator except in a
small number of patients.
6) Get rid of the ventilator as soon as
possible.
Comments
Post a Comment
Thank you! All comments go through moderation.