Respiratory Rate Normal range: 80-100mmHg

The respiratory rate is a measurement of how many

Positive End-Expiratory Pressure (PEEP)
times per minute a person exhales and inhales.
Normal range: 12–20 breaths per minute
The Positive End-Expiratory Pressure (PEEP)
ventilator setting is a way to keep clients’ lungs from
Inspiratory Flow Rate collapsing when they can’t breathe on their own.

The inspiratory flow rate is a setting on a ventilator

The PEEP setting allows oxygen to be delivered to the
used to control the amount of air that gets pushed into
bloodstream much easier, so the client can get more
a client’s lungs. It can be adjusted depending on their
oxygen into their body.
needs and their condition.

Normal range: ~0.5 ratio of the lung to the total

If you set the inspiratory flow rate too low, your client
elastance
might need more oxygen. But if you set it too high,
they might get too much oxygen, which can cause
them to feel light-headed or dizzy. Tidal Volume

The tidal volume ventilator setting is the amount of air

Normal range: between 60-90 liters/minute
that’s delivered to a client during a single breath.

Pressure Limit
Nursing consideration is also key with the tidal volume
setting when administering oxygen, since it affects the
The pressure limit setting is designed to prevent the
amount of oxygen the client receives. If a client needs
overuse of ventilators and can help nurses track how
more oxygen, then their tidal volume needs to be
much they are using. When choosing a pressure limit
increased to receive an adequate supply of oxygen.
setting, it’s important to consider factors such as the
client’s age and weight.
Normal range: 4-6-mL/kg

Normal range: Do not exceed 15–20 cmH2O/L/s

Mechanical Ventilation

Fraction of Inspired Oxygen (FiO2) Mechanical ventilation refers to a machine

mechanically giving breaths or ventilations to a client –
The FiO2 Ventilator Setting is the percentage of
like an air pump that pumps air into bicycle tires.
oxygen in the air pumped into a client’s lungs.

Mechanical ventilation is a way to provide oxygen to

When you have a client who needs supplemental
the body when it’s not able to get enough oxygen on its
oxygen, you need to set the FiO2 ventilator setting
own. It’s typically used for clients with respiratory
high enough so that they get enough oxygen (without
problems or those who have gone into a coma or are
getting too much). This will keep them from developing
otherwise unable to breathe on their own.
hypercapnia, a condition caused by too much carbon
dioxide in their bloodstream.
Types of Mechanical Ventilation laryngeal dysfunction or significant edema in their
airways to breathe more easily
Positive-Pressure Ventilation

Positive-pressure mechanical ventilation is a way to Tracheostomy management

deliver oxygen to the client. It uses a higher pressure

level to force oxygen into the lungs, rather than to -After tracheostomy, use 1 finger to assess for
allow them to expand naturally and pull in air. tightness of the ties

When clients are put on positive-pressure ventilation, - Monitor cuff pressure regularly (if applicable) to
they will be connected to the ventilator via their face or avoid tracheal injury.
chest.

- Use humidified air (or heated humidification) to

WOF! Risk for Barotrauma due to hyperinflation keep secretions moist and prevent the airway from
becoming dry and irritated

Negative-Pressure Ventilation
- Keep the stoma clean and dry to prevent infection
Negative-pressure mechanical ventilation is a type of
non-invasive mechanical ventilation that uses a
- Suction OUT not IN (No suction when inserting
ventilator to apply pressure to the lungs. It’s typically
the tube)
used for clients experiencing pneumonia, asthma,
or COPD. One of the reasons it’s so effective is that it
prevents air from leaking out of the lungs, which helps -Suction for only 10 seconds maximum
keep them inflated and able to do their job properly.

- No suction BEFORE ABG draw, wait 20 mins first

Other Ventilation Mechanisms

- No ROUTINE suction
Suction

Suction is one of the most critical components of -Always have a spare tracheostomy tube, Ambu
ventilator-assisted respiratory care. Suction is a way of bag (bag vave mask) and suction equipment
removing excess fluid from the client’s airways and available in case of tube dislodgement or obstruction.
lungs. This helps keep their airway clear so they can
breathe more easily.
ET tube management

Suctioning can be done in two ways: with

- WOF Ventillation Associated Pneumonia (VAP)
an endotracheal suction catheter (ETSC) or with
a tracheostomy tube.
- Maintain strict infection control practices, including
oral care (brushing teeth, using chlorhexidine
ETSCs help clear mucus from the lungs of clients who
mouthwash), hand hygiene, and sterile technique for
can’t cough effectively on their own. On the other
suctioning.
hand, tracheostomy tubes allow clients with permanent
- Regularly verify that the ET tube is properly - Have emergency equipment ready, such as a
positioned (usually 21-23 cm at the lip for adults) suction catheter, oxygen (non-rebreather mask or
and does not migrate. nasal cannula), and a reintubation kit in case the
patient cannot breathe effectively after extubation.

- Do 5-point check to assess for proper placement.If

the tube is too deep or in the wrong position, only one - Remove the tube gently, instructing the patient to
lung may be ventilated, leading to a significant cough or take a deep breath if possible, to facilitate
imbalance in oxygenation. removal.

-Upon auscultation, the stomach region should - Immediately place the patient on supplemental
have NO sounds oxygen to support breathing post-extubation and
prevent hypoxemia.

- Sedations are not really used in the Philippine

healthcare settings.But commonly used are (e.g., Post-Extubation
propofol, benzodiazepines)

- Position the patient comfortably (e.g., semi-

- Monitor for signs of complications such as pressure Fowler's or high-Fowler's)
ulcers from the ET tube, damage to the vocal cords,
or tracheal stenosis
- NPO

- Use humidification to prevent drying of the airway

- WOF! Atelactasis and Pneumonia(use incentive
and to thin secretions, reducing the risk of thick,
spirometry and provide oral care)
tenacious secretions.

- Monitor for other complications, such as

Extubation
laryngeal edema, stridor (squeaky sound), or
respiratory distress. If stridor occurs,notify HCP.
Extubation means taking someone off of a ventilator,
Nebulized racemic epinephrine or corticosteroids
and it’s a very delicate process. You must be careful
may be indicated to reduce swelling.
not to let the client breathe on their own before they’re
ready, but you also can’t leave them on the ventilator
for too long. If you take them off the ventilator at the Alarms
wrong time, then their lungs could collapse, and they’ll
Ventilator alarms are set up to help keep ventilator
stop breathing.
settings within a safe range and avoid over-ventilation
or under-ventilation. The alarms also alert nurses if
Extubation management they need to adjust settings based on how well clients
breathe.
- Ensure the patient is clinically stable (e.g.,
adequate oxygenation, normal vital signs, stable
blood gases).
The most common alarms and their triggers
include:

Low Pressure (Low Tidal Volume Alarm)

 Loss of connection
 Leak
 ET Tube displacement
 Disconnection

High Pressure (High Peak Pressure Alarm) Monitoring

VE
 High Blockage
 Kinks in the tube
 Minute Ventilation
 Excessive airway secretions
 Amt. of air delivered per minute
 Mucus plug
 Coughing Memory Trick: Ventilations every minute

 Pulmonary edema
 Pneumothorax Peak Inspiratory Pressure (PIP)

Modes
 Max pressure during inspiration

Assist-Control (AC) Memory Trick: PIP is the TIP of max pressure

 Assist Control Full machine control Pplat

 100% Machine control

Memory Trick: Actively Controls breathing  Plateau Pressure

 Indicates Lung compliance

Synchronized Intermittent Mandatory Ventilation  Pressure is applied to hold open small

(SIMV) airways & alveoli before expiration

Memory Trick: Plateau Pause lung

 “Weaning Mode”
 Client controls breathing mainly, but the
machine assists

Memory Trick: SIMV Step down

VENTILATOR SETTINGS