Even if pressures are set very high, bronchospasm can worsen and you may have to increase pressures even more to deliver adequate tidal volumes. The pressure will need be set very high to overcome upper airway resistance and the patient will likely not get adequate tidal volumes. Patients with severe obstructive disease will have high upper airway resistance, and therefore high PIP, but usually a low PPlat.
Recall modes that deliver pressure breaths will deliver a pre-set pressure and not a set volume. You can set your ventilator up in a pressure mode as well, but there is a reason I choose modes with volume breaths rather than pressure. Set your target tidal volumes no higher than 8 mL/kg based on ideal body weight (6-8mL/kg). Choose a mode that delivers volume breaths: Volume Assist/Control is a good option here for several reasons but there is no data to support one mode compared to others. Keys to setting up a ventilator in severe obstructive disease:ġ.Don’t forget the ventilator is a supportive measure, so continue to treat your patients severe obstructive disease: analgesia & sedation, neuromuscular blockade, bronchodilators, steroids, Magnesium…etc.Ģ. Instead of setting a high respiratory rate to blow off more CO2 like our severe metabolic acidosis patient, here, you want to set a low respiratory rate to give your patient time to empty more effectively. They both have problems with ventilation (removal of carbon dioxide), but for the patient with obstructive disease it takes a very long time to expire due to inflammation and bronchoconstriction. Obstructive Physiology: Setting up the ventilator for a patient with severe obstructive physiology like asthma or COPD is almost a completely opposite strategy compared to the patient with severe metabolic acidosis.
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