Ventilator Basics: Settings

Written By VIKTORIA SCHULER

Ventilators can look like spacecraft control panels, but once you understand the core settings, everything else falls into place. Today we're focusing on the "must-know" ventilator settings that will build your confidence and keep your patients safe.

Mode: The Ventilator's Personality

  • Volume Control (AC/VC): "I promise to deliver exactly this much air, whatever pressure it takes!"

  • Pressure Control (PC): "I'll push with exactly this much pressure, whatever volume results!"

  • SIMV: "I'll give scheduled breaths, but I'll let you breathe on your own too."

  • PSV: "I'm just here to boost your own efforts. You lead, I'll support."

Tidal Volume (VT): The Air Package Delivery

  • Standard starting point: 6-8 mL/kg of ideal body weight

  • Too high? Hello, volutrauma and barotrauma!

  • Too low? Not enough gas exchange - not a great plan either

  • Pro tip: Shorter patients need smaller tidal volumes! Calculate, don't estimate.

Rate: The Breathing Rhythm

  • Adult starting range: 12-16 breaths/minute

  • Higher rates = more minute ventilation = more CO2 removal

  • Lower rates = less minute ventilation = CO2 retention

  • Remember: Rate × Tidal Volume = Minute Ventilation

PEEP: The Alveoli's Best Friend

  • Think of it as the minimum pressure maintained to keep alveoli from collapsing

  • Standard starting point: 5 cmH2O for most patients

  • Higher PEEP (10-24 cmH2O) often needed in ARDS to recruit collapsed alveoli

  • Too much PEEP can reduce cardiac output and cause barotrauma

FiO2: The Oxygen Dial

  • Start high (100% or 1.0), then wean down to target SpO2 of 92-96% (case dependent)

  • Goal: Keep FiO2 ≤ 60% when possible to avoid oxygen toxicity

  • Remember: High FiO2 feels safe but can cause absorption atelectasis and free radical damage

The Ventilator Alarm Cheat Sheet

  • High Pressure Alarm: Check for secretions, kinked tubing, patient biting tube, coughing, or bronchospasm

  • Low Pressure Alarm: Check for disconnections, cuff leaks, or circuit leaks

  • Low Volume Alarm: Similar to low pressure - look for leaks!

  • High Respiratory Rate: Patient distress? Pain? Anxiety? Acidosis? Time to investigate

Remember: the "perfect" ventilator settings don't exist - each patient is unique. Start with standard parameters, then assess and adjust based on ABGs, patient comfort, and clinical presentation. <3

VIKTORIA SCHULER
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