F.Modify ventilator settings as indicated to maintain target values.G.Assure the non-invasive oxygen saturation (SpO2) and end tidal CO2 (EtCO2)values correlate with current ABGs.H.If rate of >30 is indicated, consider sedation prior to calling physician.I.Maximum PIP is determined by increasing PEEP in increments of 1cmH20. Stop increasing when BP, HR, SpO2 drop, or PaO2/Fio2 Ratio =<200.If the PaO2/FiO2 ratio increases you know PEEP therapy is working.J.When considering the adjustment of FiO2, hemoglobin should be checked toensure the absence of anemia. Hemodynamic data should be checked to ensureadequate circulation.2. Ventilator Management Protocol: The following are guidelines for use in stabilizationand management of the patient on mechanical ventilation:A. The following values will be maintained,
unless otherwise ordered by physician
.a.Ph: 7.35 to 7.45 b.PaCO2: 35 to 45 mmHg (EtCO2: 30 to 50 mmHg), unless the patients“usual” PaCO2 is chronically elevated.c.PaO2: 60 to 100 mmHg (SpO2 > 90%)d.In patients with COPD, adjust parameters to the patient’s “normal” valuesB. Obtain ABG or non-invasive oxygen saturation (SpO2) and end tidal CO2C.Adjust the ventilator settings to correct abnormal ABG and/or SpO2 and EtCO2values.a. Abnormal PaCO2 > 45 mmHg (EtCO2) values:1. Increase rate in increments of 2 to obtain acceptable values.2. Increase Tidal Volume by increments of 50ml to obtain acceptable values b.Abnormal PaCO2 <35 mmHg (EtCO2) values:1. Decrease rate in increments of 2 to obtain acceptable values.2. Decrease Tidal Volume by increments of 50ml to obtain acceptable values.c. Abnormal PaO2/SpO2 values:1. PaO2 <60 mmHg or SpO2 <90%, increase FiO2 in increments of 05% toobtain acceptable values.2.For hypoxia (Sa02<92%) requiring >60% Fi02, increase PEEP in steps of 1 cmH20 at a time to PEEP max (Specific Dr. order required)3.If hypoxia persists at PEEP max, increase the Fi02 in steps of 05% until100% is reached or Sp02 > 92%.4. For Sp02 >92% at PEEP maximum, Fi02 is first reduced in steps of 05%until <= 60%, then PEEP is reduced in steps of 1 to a minimum of 5 beforefurther reduction in Fi02.