From the Guidelines
To adjust ventilator settings for a patient after cardiac arrest, focus on changing the tidal volume to 6-8 ml/kg ideal body weight, respiratory rate to 12-20 breaths/minute, FiO2 to maintain SpO2 >94%, and PEEP to 5-10 cmH2O, while avoiding hyperventilation and targeting normocapnia 1. When adjusting ventilator settings, it is essential to consider the patient's current status, including oxygen saturation, blood gases, and compliance.
- Make one change at a time, allowing 15-20 minutes between adjustments to evaluate the effect.
- Increase ventilatory support if the patient shows signs of respiratory distress or poor oxygenation, and decrease support when the patient improves.
- Regular reassessment is crucial, including checking blood gases after significant changes. The goal is to provide sufficient respiratory support while working toward ventilator weaning when appropriate and preventing ventilator-induced lung injury, as supported by the European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care 1. Additionally, the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care recommend avoiding hyperventilation and targeting normocapnia to prevent cerebral vasoconstriction and decreased cerebral blood flow 1. It is also important to consider the use of protective lung ventilation strategies, such as tidal volume 6-8 ml/kg ideal body weight and positive end-expiratory pressure 4-8 cm H2O, as recommended by the European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care 1. However, the most recent and highest quality study, the 2020 evidence-based management guideline for the COVID-19 pandemic, recommends usage of low tidal volumes (4-8 ml/kg predicted body weight) and target plateau pressure <30 cmH2O, which should be considered in the context of post-cardiac arrest care 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Ventilator Settings for Acute Respiratory Distress Syndrome (ARDS)
To change the vent settings for ARDS, consider the following:
- The therapeutic range of Positive End-Expiratory Pressure (PEEP) is relatively narrow, and the ARDS Network PEEP/FIO2 strategy is reasonable and supported by high-level evidence 2.
- Lung-protective mechanical ventilation is recommended as an initial approach to mechanical ventilation in both perioperative and critical care settings, with principles including:
- Prevention of volutrauma (tidal volume 4 to 8 ml/kg predicted body weight with plateau pressure <30 cmH2O)
- Prevention of atelectasis (positive end-expiratory pressure ≥5 cmH2O, as needed recruitment maneuvers)
- Adequate ventilation (respiratory rate 20 to 35 breaths per minute)
- Prevention of hyperoxia (titrate inspired oxygen concentration to peripheral oxygen saturation (SpO2) levels of 88 to 95%) 3
- The standard ventilator settings that best identify patients with established ARDS and predict differences in intensive care unit (ICU) mortality are PEEP ≥10 cmH2O and FIO2 ≥0.5 4.
- Increasing FIO2 above 0.7 is associated with a significant increase in PaO2/FIO2 ratio, and FIO2 should be carefully defined for the screening of lung-injured patients 5.
- For patients with severe lung injury and/or abnormal chest-wall compliance, highly individualized titration of PEEP, based upon the respiratory-system pressure-volume curve, PEEP/tidal-volume titration grids, or a recruitment maneuver and a PEEP decrement trial, is a reasonable alternative 2.
Key Considerations
- The PEEP/FIO2 tables provide a guide to balancing PEEP and FIO2 settings in adults with ARDS, but the best approach may vary depending on the individual patient's condition 2, 6.
- Protective ventilation is a measure that is proven to reduce mortality in patients with ARDS, when systematically and consistently applied 6.