Mechanical Ventilation PDF - 10 Dec 2024

‫كليـــــــة االتحــــــــاد الدوليـــــــــة للـــعــــلوم الطـــــبية‬ Uonin collage for medical signs Intensive Care Unit Devices MECHANICAL VENTILATION 3ed year respiratory therapist student Dr:MOHAMMED-SENAN BS,Fniv, RCP, MsRC 10-De...

‫كليـــــــة االتحــــــــاد الدوليـــــــــة للـــعــــلوم الطـــــبية‬ Uonin collage for medical signs Intensive Care Unit Devices MECHANICAL VENTILATION 3ed year respiratory therapist student Dr:MOHAMMED-SENAN BS,Fniv, RCP, MsRC 10-Dec-24 DrMohammmed Senana 1  Introduction What is Mechanical Ventilation? Mechanical Ventilation is a form of therapy that is used on patients who are unable to breathe on their own. A certain level of ventilation is required in order to maintain the proper levels of oxygen and carbon dioxide in the body. This process is referred to as Gas Exchange. A Mechanical Ventilator is a device that is used to provide positive pressure ventilation in order to help normalize a patient’s arterial blood gas levels to maintain an adequate acid-base balance  Introduction Mechanical Ventilation is a form of life support that is indicated in critically ill patients in the Intensive Care Unit (ICU) for short-term or long-term use. It’s often used to treat patients with cardiopulmonary disorders but is also used on postoperative patients who are recovering from anesthesia and sedation. The ventilator can provide a full cycle of breathing during both inspiration and expiration so that the patient does not have to do any work while recovering from the underlying condition. In summary — whenever a patient is unable to ventilate or breathe on their own, this is where Mechanical Ventilation comes into play.  Introduction What is Mechanical Ventilation? As I mentioned, a Mechanical Ventilator is a machine that aids in a patient’s ability ventilate. That’s where it gets its name. In other words, it helps the patient take in oxygen and remove carbon dioxide from the lungs. While p.t on a ventilator machine, a hollow tube, known as an Endotracheal Tube, connects the patient to the machine. The patient stays on ventilator until he or she is able to achieve spontaneous breathing on their own.  Introduction What is Mechanical Ventilation? It’s important to keep in mind that the use of this machine does not completely heal the condition of the patient. Rather, it helps the patient achieve a stabilization while medications and other treatment modalities are used to promote healing of the underlying condition.  WHY ARE VENTILATORS USED? To get oxygen into the lungs. To get the lungs get rid of carbon dioxide. CO2 O2 10-Dec-24 DrMohammmed Senana 6  Benefits of Mechanical Ventilation There are many benefits for patients who are receiving Mechanical Ventilation. These include the following: It helps decrease the patient’s work of breathing which helps the respiratory muscles rest and recover. It helps the patient get adequate amounts of oxygen. It provides stability and allows medications to work while the patient heals. It helps the patient achieve adequate ventilation by removing carbon dioxide for effective gas exchange. There are many benefits of Mechanical Ventilation. These are just some of the most common examples.. Basic Components Of Ventilator:- 10-Dec-24 DrMohammmed Senana 8 Basic Components Of Ventilator:- 10-Dec-24 DrMohammmed Senana 9 TYPES OF VENTILATORs 1.Negative Pressure Ventilators (Iron Lung, Chest Cuirass):- Apply negative pressure (relative to atmospheric) to the body surface (at least the rib cage and abdomen) – such devices are called Negative Pressure Ventilators. ADVANTAGES:- dose not by pass body’s natural defenses, rugged, durable, easy to operate. DISADVANTAGES :- strict controller, Isolates patient, restricts nursing care. An Emerson iron lung 10-Dec-24 DrMohammmed Senana 10 TYPES OF VENTILATORs 10-Dec-24 DrMohammmed Senana 11 Who’s Watching the Patient? An iron lung ward filled with polio patients, Rancho Los Amigos Hospital, 1953 10-Dec-24 DrMohammmed Senana 12 The cuirass ventilator with the A modern cuirass with its motor, A patient (Model) showing the way bellows and the motor bellows and controls the cuirass is applied 10-Dec-24 DrMohammmed Senana 13 TYPES OF VENTILATORs 2. Positive Pressure Ventilator : (therapy of choice today) Apply positive pressure (relative to atmospheric) to the airway opening More flexible in its range of settings, less clumsy. 10-Dec-24 DrMohammmed Senana 15 Positive Pressure Ventilation Positive pressure ventilation (PPV) occurs when a mechanical ventilator is used to deliver air into the patient’s lungs by way of an endotracheal tube or positive pressure mask. For example, if the pressure at the mouth or upper airway is +15 cm H2O and the pressure in the alveolus is zero (end exhalation), the gradient between the mouth and the lung is PTA = Pawo − Palv = 15 − (0), = 15 cm H2O. Thus air will flow into the lung. Positive Pressure Ventilation At any point during inspiration, the inflating pressure at the upper (proximal) airway equals the sum of the pressures required to overcome the resistance of the airways and the elastance of the lung and chest wall. During inspiration, the pressure in the alveoli progressively builds and becomes more positive. The resultant positive alveolar pressure is transmitted across the visceral pleura, and the intrapleural space may become positive at the end of inspiration. Positive Pressure Ventilation At the end of inspiration, the ventilator stops delivering positive pressure. Mouth pressure returns to ambient pressure (zero or atmospheric). Alveolar pressure is still positive, which creates a gradient between the alveolus and the mouth, and air flows out of the lungs. High-Frequency Ventilation High-frequency ventilation uses above-normal ventilating rates with below-normal ventilating volumes. There are three types of high frequency ventilation strategies: - High-frequency positive pressure ventilation (HFPPV), which uses respiratory rates of about 60 to 100 breaths/min; High-frequency jet ventilation (HFJV), which uses rates between about 100 and 400 to 600 breaths/min; High-frequency oscillatory ventilation (HFOV), which uses rates into the thousands, up to about 4000 breaths/min. In clinical practice, the various types of high-frequency ventilation are better defined by the type of ventilator used rather than the specific rates of each. CLASSIFICATION OF M.V 1. INVASIVE Invasive ventilation is positive pressure ventilation applied via an endotracheal or tracheotomy tube. 2. NON-INVASIVE Non-Invasive ventilation is positive pressure ventilation applied via a mask covering the mouth and nose or just the nose. 10-Dec-24 DrMohammmed Senana 20 First Rule One in MV Learning : look to the patient first, and then look to the machine. 10-Dec-24 DrMohammmed Senana 21 Natural & Mechanical Ventilation 10-Dec-24 DrMohammmed Senana 22 10-Dec-24 DrMohammmed Senana 23 10-Dec-24 DrMohammmed Senana 24 Indications for Mechanical Ventilation In general, Mechanical Ventilation is indicated whenever a patient’s spontaneous breathing is not adequate enough to sustain life. The following conditions in which ventilatory support is needed. Insufficient Oxygenation Inadequate oxygenation, which is known as hypoxemia, can impact the functionality of tissues and vital organs in the body if left untreated. Mechanical Ventilation helps treat hypoxemia by providing a sufficient amount of oxygen into the lungs so that it can be distributed throughout the body. Indications for Mechanical Ventilation Insufficient Ventilation Healthy lungs work to remove carbon dioxide from the body. Mechanical ventilatory support is indicated if the patient has inadequate ventilation by the lungs. It’s common in conditions with apnea, chronic respiratory acidosis, such as COPD, and neuromuscular disorders. Acute Lung Injury An acute injury to the lungs that occurs from an event such as sepsis, pneumonia, aspiration, or trauma. Severe Asthma Mechanical Ventilation may be indicated in patients who are experiencing a severe asthma attack that requires intubation. Indications for Mechanical Ventilation Severe Hypotension Mechanical Ventilation may be indicated in severe episodes of low blood pressure, such as with shock, sepsis, and Congestive Heart Failure (CHF). Inability to Protect the Airway An unconscious patient with breathing difficulties may be at an increased risk for aspiration. Aspiration occurs when the patient accidentally inhales nasal and oral secretions directly into the lungs. Establishing a patent airway and maintaining spontaneous breathing via Mechanical Ventilation can help prevent this from occurring. There are other indications for Mechanical Ventilation as well, depending on the patient’s condition. These are just some of the most common examples that you should know as a practitioner. Contraindications for Mechanical Ventilation Contraindications for Mechanical Ventilation A patient cannot survive unless they are receiving adequate ventilation and oxygenation. This means that there are no absolute contraindications for Mechanical Ventilation. If a patient is in need of full ventilatory support, they are likely to need Mechanical Ventilation. There really is no way around it. The only contraindication for Mechanical Ventilation is if the patient legally and specifically states that they do not wish to be intubated or receive life support. This is referred to as a DNI order, or Do Not Intubate. In such a case, the patient may receive Bilevel Positive Airway Pressure (BiPAP) instead as a form of Noninvasive Ventilation..  REMEMBER The First Rule of health care is “ Do No Harm ”. With this in mind , the 2nd Rule of Mechanical Ventilation is “ Know Your Equipment ”. In all events in-between , look to the patient first, and then look to the machine. Before connecting a patient to a ventilator, verify that the ventilator has been set up for that patient. Mechanical ventilation should begin and end with the caregiver looking at the patient, and seeing a human being. 10-Dec-24 DrMohammmed Senana 29  Complications of Mechanical Ventilation Most common complications. Barotrauma In This condition the alveoli of the lungs rupture due to overinflation from increased pressure levels. As a result, the lungs collapse which leads to very serious lung conditions that can affect breathing. Volutrauma This condition occurs when the alveoli become filled with fluid due to high tidal volumes. Tidal volume refers to the amount of the air transported into the lungs during inhalation. Volutrauma commonly occurs in patients with Acute Respiratory Distress Syndrome (ARDS) and those who had a blood transfusion.  Complications of Mechanical Ventilation Ventilator-Associated Pneumonia (VAP) This condition is a lung infection that develops 48 hours or more after a patient has been intubated and placed on the ventilator. Because Mechanical Ventilation involves the insertion of tubes into the airway, this increases the chances of various microorganisms entering the lungs. Auto-PEEP Auto-PEEP, or Intrinsic PEEP, is characterized by over-inflation of the lungs due to large tidal volumes, restrictive airways, or a prolonged inhalation time. If left untreated, this condition can progress to barotrauma and collapsed lungs.  Complications of Mechanical Ventilation Oxygen Toxicity This occurs when a patient receives too much oxygen for too long of a period of time. In general, patients who receive an FiO2 > 60% for extended periods of time are at risk of oxygen toxicity. There are other complications of Mechanical Ventilation as well, depending on the patient’s unique condition. These are just some of the most common examples to expect as a practitioner.  Ventilator Mode What is a Ventilator Mode? A ventilator mode is a way of describing how the mechanical ventilator assists the patient with inspiration. The characteristics of a particular mode controls how the ventilator functions. Understanding the different ventilator modes is one of the most important aspects of mechanical ventilation. Primary Control Variables: In mechanical ventilation, there are two primary control variables: 1. Volume Control 2. Pressure Control  Ventilator Mode Volume Control ▪ Volume Control means that you can set (or control) the patient’s tidal volume. ▪ So with a set tidal volume and a set respiratory rate, this means that there is a known minute ventilation. This is good when it comes to making adjustments to achieve a desired PaCO2. ▪ One of the negative aspects of using Volume Control is that, since the tidal volume is preset, if the patients lung compliance were to decrease, this could result in high peak pressures. ▪ Another drawback of Volume Control is patient-ventilator dyssynchrony.  Ventilator Mode Pressure Control Pressure Control means that you can set (or control) the patient’s pressure in order to achieve a desired tidal volume. As with Volume Control, a Pressure-Controlled tidal volume and set rate can help you reach a desired PaCO2. The main disadvantage of using Pressure Control is the patient’s tidal volume can potentially be unstable if there are changes in the patient’s lung compliance or airway resistance. So again, Volume Control and Pressure Control — those are the two control variables. When initiating mechanical ventilation on a patient, once you select the control variable, now you can choose the actual operational mode that determines the pattern of breathing for the patient..  Ventilator Mode Primary Ventilator Modes In mechanical ventilation, there are two primary ventilator modes: 1. Assist/Control (A/C) Mode 2. Synchronous Intermittent Mandatory Ventilation (SIMV) Mode Assist/Control (A/C) Mode In this mode, a minimum number of preset mandatory breaths are delivered by the ventilator but the patient can also trigger assisted breaths. The patient makes an effort to breathe and the ventilator assists in delivering the breath. With that said, this mode of ventilation does not allow the patient to take spontaneous breaths. In this mode, the operator can set either a controlled pressure or a controlled volume.  Ventilator Mode Primary Ventilator Modes Assist/Control (A/C) Mode The sensitivity control can be adjusted to make it easier or harder for the patient to initiate a breath. When to Use Assist/Control? Is most often used when mechanical ventilation is first initiated for a patient because this mode provides full ventilatory support. That is also one of the advantages of using Assist/Control because it keeps the patient’s work of breathing requirement very low. One of the major complications of Assist/Control is hyperventilation, which results in respiratory alkalosis. This is the result of too many breaths given to the patient, whether patienttriggered or machine-triggered.  Ventilator Mode Primary Ventilator Modes Synchronous Intermittent Mandatory Ventilation (SIMV) Mode In this mode, the ventilator delivers a preset minimum number of mandatory breaths. However, it also allows the patient to initiate spontaneous breaths in between the mandatory breaths. This mode also allows the operator to set either a controlled pressure or a controlled volume. When to Use SIMV? The primary indication for SIMV is when a patient needs partial ventilatory support. That is because, since the patient can takes spontaneous breaths, that means they can contribute to some of their minute ventilation. SIMV is a mode that is used for weaning as well.  Ventilator Mode Primary Ventilator Modes Synchronous Intermittent Mandatory Ventilation (SIMV) Mode Advantages of Using SIMV: Since the patient is able to take spontaneous breaths, it helps to maintain their respiratory muscle strength and avoid muscular atrophy. It distributes tidal volumes evenly throughout the lung fields, which reduces V/Q mismatching. It helps to decrease the patient’s mean airway pressure. As a Respiratory Therapist (or student), SIMV and Assist/Control are the two ventilator modes that you should be most familiar with. However, it’s also important to develop an understanding of the spontaneous modes and the secondary modes of mechanical ventilation as well.  Ventilator Mode Spontaneous Ventilator Modes Keep in mind that, in order to use any of the following modes, the patient must be breathing spontaneously. Continuous Positive Airway Pressure (CPAP) In CPAP, or continuous positive airway pressure, a continuous pressure that is above atmospheric pressure is maintained throughout the breathing cycle. The patient must be breathing spontaneously to be in this mode because no mandatory breaths are given. This is a useful mode for weaning patients off of the ventilator.  Ventilator Mode Spontaneous Ventilator Modes Pressure Support Ventilation (PSV) A mode of mechanical ventilation in which the patient’s spontaneous breaths are supported by the ventilator during the inspiratory phase of breathing. As the patient triggers a breath, the ventilator assists by adding pressure to make breathing easier. The level of pressure is preset by the operator, so you have control over how much support you give the patient. For example, the higher the level of pressure support that is set, the easier it will be for the patient to take a breath. In PSV, the breaths are time-cycled and pressure-limited. PSV is often used to help the patient overcome the airway resistance that is caused by the endotracheal tube.  Ventilator Mode Spontaneous Ventilator Modes Pressure Support Ventilation (PSV) PSV is often used to help the patient overcome the airway resistance that is caused by the endotracheal tube. For example, let’s say there is a patient who needs to be weaned from the ventilator that is in the SIMV mode. If their endotracheal tube size is too small, the airway resistance would be increased which would make weaning difficult. That’s when PSV would come in handy to help the patient overcome the airway resistance so that they can be extubated.  Ventilator Mode Spontaneous Ventilator Modes Volume Support (VS) A mode of mechanical ventilation in which the ventilator delivers a supported breath to help the patient reach a set tidal volume. This mode is totally dependent on the patient’s effort, meaning that, the machine varies the inspiratory pressure support level with each breath in order to achieve the target volume. This mode is not quite as common as some of the others, but it’s often used to wean patients from anesthesia.. Ventilator Mode Others Ventilator Modes Previous are primary and spontaneous modes of ventilation, now unconventional ventilator modes. These are sometimes referred to as the secondary modes of ventilation. 1. Control Mode Ventilation (CMV) 2. Airway Pressure Release Ventilation (APRV) 3. Mandatory Minute Ventilation (MMV) 4. Inverse Ratio Ventilation (IRV) 5. Pressure Regulated Volume Control (PRVC) 6. Proportional Assist Ventilation (PAV) 7. Adaptive Support Ventilation (ASV) 8. Adaptive Pressure Control (APC) 9. Volume-Assured Pressure Support (VAPS) 10. Neurally Adjusted Ventilatory Assist (NAVA) 11. Automatic Tube Compensation (ATC) 12. High-Frequency Oscillatory Ventilation (HFOV)  Ventilator Mode Others Ventilator Modes 1. Control Mode Ventilation (CMV) It’s a mode where the ventilator delivers a preset tidal volume at a set time-triggered frequency. Basically, the ventilator controls both the rate and tidal volume which means that it’s in total control of the minute ventilation. This mode should only be used on patients who are fully sedated and have been administered neuromuscular blocking agents. That is also the biggest hazard of using this mode because, since the patient is fully dependent on the machine for ventilation and oxygenation, it could be devastating if they were to become disconnected. 2- APRV ( Airway Pressure Release Ventilation ) A mode of mechanical ventilation in which two levels of continuous positive airway pressure are applied with an intermittent release phase for spontaneous breaths. This mode is often recommended to improve oxygenation and treat refractory hypoxemia. Other indications for APRV include an Acute Lung Injury (ALI), Acute Respiratory Distress Syndrome (ARDS), and Severe Atelectasis. Settings for APRV: High Pressure Low Pressure High Time Low Time 3- ASV (Adaptive Support Ventilation ) A mode of ventilation that changes the number of mandatory breaths and pressure support level according to the patient’s breathing pattern 4-MMV (Mandatory Minute Ventilation) This is a feature of some ventilators that causes an increase in the mandatory breaths that are delivered when the patient’s spontaneous breathing level becomes inadequate. So basically, if the patient’s spontaneous breathing decreases, the ventilator compensates in order to make sure that a safe minimal minute ventilation is delivered. MMV is often an additional function of the SIMV mode and is intended to prevent hypercapnia. 7-PRVC (PRESSURE REGULATED VOLUME CONTROL) A mode of mechanical ventilation that provides volume-controlled breaths with the lowest pressure possible. It does so by altering the flow and inspiratory time. This mode is used to keep the peak airway pressure at the lowest possible level. This mode is volume-cycled and can be patient triggered-or time triggered. 8-PAV (Proportional Assist Ventilation) This is a mode of mechanical ventilation where the machine uses variable pressure to provide pressure support for a patient’s spontaneous breaths. The level of pressure support is adjusted depending on the patient’s work of breathing. PAV is either pressure-triggered or flow-triggered, and the breathing cycle ends once the patient’s volume or flow demands are met. One thing to keep in mind about this mode is that, if the patient’s lungs show rapid improvement, overdistention or barotrauma could occur because too much pressure would be delivered. 9-VAPS ( Volume Assured Pressure Support Ventilation ) A mode of ventilation that provides a stable tidal volume by incorporating inspiratory pressure support ventilation along with conventional volume- assisted cycles. It’s only available on certain ventilators. This mode can cause a prolonged inspiratory time, so patients with an obstructive disease should be monitored closely in order to prevent air trapping or other cardiovascular effect.  Ventilator Settings What are Ventilator Settings? To give a brief definition, ventilator settings are the controls on a mechanical ventilator that can be set or adjusted in order to determine the amount of support that is delivered to the patient. Support can be provided in the form of ventilation and oxygenation. You must develop an understanding of how each setting can be adjusted in order to provide more or less of each type of support for the patient. The good news is, that is exactly what we’re going to cover in this article.  Ventilator Settings Examples of the Basic Ventilator Settings: Mode Tidal Volume Frequency (Rate) FiO2 Flow Rate I:E Ratio Sensitivity PEEP Alarms we’re going to provide a detailed overview of each.  Ventilator Settings Basic Ventilator Settings Explained: Each setting can be controlled or adjusted depending on the patient’s condition and needs. ❑ Tidal Volume Tidal Volume refers to the volume of air that is inhaled and exhaled from the lungs during normal breathing. The tidal volume setting on the ventilator determines how much air is delivered to the lungs by the machine. ❑ Frequency (Respiratory Rate) The respiratory rate, also referred to as the breathing rate, is simply the rate at which breathing occurs. It typically refers to the number of breaths that are taken per minute and the normal range is 10-20 breaths/minute. The frequency setting on the ventilator determines how many breaths are delivered to the patient by the machine. Ventilator Settings Basic Ventilator Settings Explained: ❑ Fraction of Inspired Oxygen (FiO2) The FiO2, or fraction of inspired oxygen, is the concentration of oxygen that is being inhaled by the patient. For patient with severe hypoxemia, an FiO2 of 100% may be required when mechanical ventilation is initiated. But you goal should be to wean the FiO2 down to the lowest possible level that provides adequate oxygenation. If a patient receives an FiO2 > 60% for a prolonged period of time, it increased their chances of oxygen toxicity. Ventilator Settings Basic Ventilator Settings Explained: ❑ Flow Rate The inspiratory flow rate is a rate that controls how fast a tidal volume is delivered by the ventilator. The setting can be adjusted depending on the patient’s inspiratory demands. The normal inspiratory flow rate should be set at around 60 L/min. With that said, most ventilators can deliver up to 120 L/min if a patient needs a prolonged expiratory which is necessary when obstructive diseases are present. If the flow rate is set too low, it could result in patient-ventilator dyssynchrony and an increased work of breathing. If the flow rate is set too high, it could result in decreased mean airway pressures. Ventilator Settings Basic Ventilator Settings Explained: ❑ Inspiratory-to-Expiratory Ratio (I:E Ratio) The I:E ratio refers to a ratio of the inspiratory portion compared to the expiratory portion of the breathing cycle. For patients on the ventilator, the normal I:E ratio is between 1:2 and 1:4. A larger I:E ratio may be delivered if a patient is in need of a longer expiratory time due to the possibility of air trapping. The I:E ratio can be adjusted by making changes to the flow rate, inspiratory time, expiratory time, tidal volume, and frequency settings. Ventilator Settings Basic Ventilator Settings Explained: ❑ Trigger Sensitivity The sensitivity control is what determines how much effort (negative pressure) the patient must generate in order to trigger a breath from the machine. The normal sensitivity setting should be set between -1 and -2 cmH2O. If the sensitivity is set too high, it will cause the ventilator to initiate auto-triggering and increase the total frequency of 28 breaths. If it’s set too low, the patient could have a difficult time initiating a breath. Ventilator Settings Basic Ventilator Settings Explained: ❑ Positive End Expiratory Pressure (PEEP) PEEP is a positive pressure that is delivered during the expiratory phase of the breathing cycle in order to prevent the closure of alveoli and allow increased time for oxygen exchange to occur. It’s typically indicated in patients with refractory hypoxemia and those who have not responded well to a high FiO2. ❑ Ventilator Alarms A ventilator alarm is a safety mechanism on a mechanical ventilator that uses set parameters to provide alerts whenever there is a potential problem related to the patient-ventilator interaction. Ventilator Settings Basic Ventilator Settings Explained: ❑ Ventilator Alarms Common Ventilator Alarms Include: High Pressure Low Pressure Low Expired Volume High Frequency Apnea High PEEP Low PEEP Ventilator Settings Basic Initial Ventilator Settings : Initial Ventilator Settings Once it has been determined that mechanical ventilation is indicated for a patient who needs help with oxygenation and/or ventilation, then you must know how to properly input the initial settings. Each mechanical ventilator machine is different, so be sure to abide by the guidelines provided by the manufacturer. However, here are some general guidelines that you can use when determining the initial ventilator settings. Ventilator Settings Basic Initial Ventilator Settings : ❖ Mode Any operational mode will work when setting up the initial ventilator settings! Don’t get too caught up on deciding on the right mode,. With that said, just as a reminder, you can select A/C in the patient needs full support or SIMV if they only need partial support. ❖ Tidal Volume The initial tidal volume setting should be 5 – 10 mL/kg of the patient’s ideal body weight (IBW). ❖ Frequency The initial frequency setting should be 10 – 20 breaths/min. Ventilator Settings Basic Initial Ventilator Settings : ❖ FiO2 The initial FiO2 setting should be 30 – 60% unless the patient was previously receiving an higher percentage of oxygen before intubation. Then you would use that previous FiO2. Strive to provide the lowest concentration of oxygen that’s possible to maintain a normal PaO2. An FiO2 up to 100% as an initial setting is appropriate for patients with severe oxygenation issues. ❖ Flow Rate The initial flow setting should be 40 – 60 L/min. Ventilator Settings Basic Initial Ventilator Settings : ❖ I:E Ratio The initial I:E ratio setting should be 1:2 – 1:4. ❖ Sensitivity The initial sensitivity setting should be between -1 and -2. ❖ PEEP The initial PEEP setting should be 4 – 6 cmH2O  Thank you for attention ,,, 10-Dec-24 DrMohammmed Senana 64  Have a great day DrMohammmed Senana 10-Dec-24 65