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Conventional Mechanical Ventilation: Initial Settings by Barry Grenier.

Hello. My name's Barry Grenier. I'm the education coordinator in the Respiratory Care Department at Boston Children's Hospital. And today, I'd like to outline a practical approach for choosing initial ventilator settings for a range of pediatric patients being ventilated with a conventional mechanical ventilator.

Now, this discussion assumes that you've got a ventilator that's set up with a circuit and accessories appropriate for your patient's size, and that you put the ventilator through a preuse check as per the manufacturer's recommendations. And we'll do an overview of a choice of mode of ventilation, choosing ventilator settings that define the mandatory breath type that you're using in that mode of ventilation, choosing the other ventilator settings applicable in that mode, and finally we'll talk a little bit about using pressure support and modes of ventilation that allow spontaneous breaths.

Determining Appropriate Mode of Ventilation.

Now choosing the mode of ventilation may seem daunting due to the proliferation of modes and mode names that have appeared on mechanical ventilators. But it may help to try to simplify the process a little bit by stating that all modes of ventilation can be fit into three main mode families Continuous Mandatory Ventilation, Intermittent Mandatory Ventilation, and Continuous Spontaneous Ventilation. And that these modes contain breaths that are either volumecontrolled or pressurecontrolled.

With Continuous Mandatory Ventilation, all breaths are mandatory. And these would include the socalled assistcontrol modes that we have traditionally used. The Intermittent Mandatory Ventilation modes offer a combination of mandatory and spontaneous breaths, and Continuous Spontaneous Ventilation would include those modes of ventilation where all breaths are spontaneous. With volumecontrolled breaths, the tidal volume and the flow rate are set and delivered consistently from breath to breath to breath.

And to do that, the ventilator will vary the pressure as needed. With pressurecontrolled breaths, the ventilator pressure is predetermined and volumes and flows are, to some degree, variable. With pressurecontrolled, the target pressure can be set but sometimes in some of the newer modes of ventilation the pressure's controlled by the ventilator to achieve a target tidal volume. So in modes such as Pressure Regulated Volume Control, if you dig into what's happening with that breath, the breath is volume targeted but it is delivered as a pressurecontrolled breath.