<commit_before>---

title: 'Ventilator Setting for Obstructive Lung Disease'
authors:
    - '<NAME>, MD'
created: 2011/10/21
updates: null
categories:
    - Pulmonology
    - 'Critical Care'
drugs: null

---



# Ventilator Setting for Obstructive Lung Disease

**Goal in obstruction** (asthma/COPD): Give the patient time to exhale

Initial vent settings for patient with predicted body weight = 70 kg (5'9" male; 5'11" female)

<table>
<colgroup>
<col width="50%" />
<col width="50%" />
</colgroup>
<tbody>
<tr class="odd">
<td><ul>
<li>Mode = Volume Assist Control (AC)</li>
<li>Tidal volume = 560 mL</li>
<li>Inspiratory flow rate = 80 L/min</li>
<li>Respiratory rate = 10</li>
</ul></td>
<td><ul>
<li>FiO2 = 100%</li>
<li>PEEP = 0-5</li>
<li>Goal plateau P &lt; 30 cmH2O</li>
</ul></td>
</tr>
</tbody>
</table>

**Ventilator Mode =** **Volume Assist Control (AC)
**

**Tidal Volume** (Vt) = 8 mL/kg 

-   Based on <span class="aglmd-moreinfo ui-moreinfo" data-iid="53aa2472d35d3ae92e00152f">predicted body weight (kg)</span>

**Inspiratory Flow Rate** (IFR) = **80-100 L/min** 

-   Increase IFR and ensure adequate sedation if patient uncomfortable or sucking on tube

**Respiratory rate** (RR) = Start at **10**, then adjust to give time to exhale (IMPORTANT)

-   Goal I:E of 1:4 or 1:5
-   Permissive hypercapnea, as long as pH stays above 7.2.
-   Prevents air-trapping/auto PEEP

**FiO2 and PEEP **= Start at **FiO2 100%** and **PEEP 0-5** 

-   Goal SpO2 = 92-95%
-   Can usually quickly titrate down the FiO2

**Plateau Pressure**

-   Goal P(plat) &lt; 30 cm H2O
-   Check after initial settings and at regular intervals thereafter
-   Technique: Press inspiratory hold button for 0.5 sec and look at pressure gauge 
-   If P(plat) &gt; 30 cm H2O, investigate possible air trapping

**Air-trapping (Auto-PEEP)**

-   Air trapping (auto-PEEP) = gas trapped in alveoli at end-expiration
-   Suspect auto-PEEP if P(plat) &gt; 30 cm H2O, or if hypotension develops
-   First step is to disconnect vent and allow trapped air to escape
-   Prevent further air trapping by decreasing RR and increasing expiratory time

**![](image-1.png)***[EMcrit.org](http://emcrit.org/podcasts/vent-part-2/)*

## References

-   [www.EMcrit.org](www.EMcrit.org)
-   [<NAME>, <NAME>, <NAME>. Intubation and mechanical ventilation of the asthmatic patient in respiratory failure. J Emerg Med. 2009 Aug;37(2 Suppl):S23-34. doi: 10.1016/j.jemermed.2009.06.108.](https://www.ncbi.nlm.nih.gov/pubmed/19683662/)
<commit_msg>vent obstr: copyedits<commit_after>---

title: 'Ventilator Setting for Obstructive Lung Disease'
authors:
    - '<NAME>, MD'
created: 2011/10/21
updates: null
categories:
    - Pulmonology
    - Critical Care
drugs: null

---



# Ventilator Setting for Obstructive Lung Disease

**Goal in obstruction** (asthma/COPD): Give the patient time to exhale

Initial vent settings for patient with predicted body weight = 70 kg (5'9" male; 5'11" female)

<table>
<colgroup>
<col width="50%" />
<col width="50%" />
</colgroup>
<tbody>
<tr class="odd">
<td><ul>
<li>Mode = Volume Assist Control (AC)</li>
<li>Tidal volume = 560 mL</li>
<li>Inspiratory flow rate = 80 L/min</li>
<li>Respiratory rate = 10</li>
</ul></td>
<td><ul>
<li>FiO2 = 100%</li>
<li>PEEP = 0-5</li>
<li>Goal plateau P &lt; 30 cmH2O</li>
</ul></td>
</tr>
</tbody>
</table>

**Ventilator Mode =** Volume Assist Control (AC)

**Tidal Volume** (Vt) = 8 mL/kg 

-   Based on predicted body weight (kg)

**Inspiratory Flow Rate** (IFR) = 80-100 L/min 

-   Increase IFR and ensure adequate sedation if patient uncomfortable or sucking on tube

**Respiratory rate** (RR) = Start at 10, then adjust to give time to exhale **(IMPORTANT)**

-   Goal I:E of 1:4 or 1:5
-   Permissive hypercapnea, as long as pH stays above 7.2
-   Prevents air-trapping/auto PEEP

**FiO2 and PEEP**= Start at FiO2 100% and PEEP 0-5

-   Goal SpO2 = 92-95%
-   Can usually quickly titrate down the FiO2

**Plateau Pressure**

-   Goal P(plat) &lt;30 cm H2O
-   Check after initial settings and at regular intervals thereafter
-   Technique: Press inspiratory hold button for 0.5 sec and look at pressure gauge 
-   If P(plat) &gt;30 cm H2O, investigate possible air trapping

**Air-Trapping (Auto-PEEP)**

-   Air trapping (auto-PEEP) = gas trapped in alveoli at end-expiration
-   Suspect auto-PEEP if P(plat) &gt;30 cm H2O, or if hypotension develops
-   First step is to disconnect vent and allow trapped air to escape
-   Prevent further air trapping by decreasing RR and increasing expiratory time

**![](image-1.png)

*[EMcrit.org](http://emcrit.org/podcasts/vent-part-2/)*

## References

-   [www.EMcrit.org](www.EMcrit.org)
-   [<NAME>, <NAME>, <NAME>. Intubation and mechanical ventilation of the asthmatic patient in respiratory failure. J Emerg Med. 2009 Aug;37(2 Suppl):S23-34. doi: 10.1016/j.jemermed.2009.06.108.](https://www.ncbi.nlm.nih.gov/pubmed/19683662/)

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