1

Terminology
– f: rate of breathing

– Vt: Tidal volume

– VA: Alveolar ventilation

– VD: dead space = 2.2 ml/ kg

– FiO2: fraction of inspired O2

– PEEP: Positive End Expiratory Pressure

– PASB : Pressure Above Spontaneous Breathing

– ASB : Assisted Spontaneous Breathing

2
 Basic pulmonary physiology
 Air that moves in and out of a patient's lungs per
minute that is 7-10 L/min  Minute volume (MV)
MV =Vt x f
 Alveolar ventilation (VA)  in contact with the
alveolar-capillary gas exchange interface
 VA = (Vt - VD ) x f
Volume-pressure relation: P = V/C

3
 Plateau pressure (static pressure)
• … is the pressure at the end of inspiration
with a short breath hold
• It should not be exceed 30 cmH2O

• P plateau ~ 1/compliance (P = V/C)

• volume = P plateau

4
 Pressure-time diagram for
volume controlled constant
flow ventilation

5
 Peak Airway Pressure
(dynamic pressure)
• …. is pressure during inspiration

• So related to both airway resistance and compliance

• compliance and/or resistance  P peak

• P peak – P plateau < 4 cm H2O (normal gradient)

• P peak is a vital sign for mechanically ventilated
patients.
• P peak < 35 cmH2O
6
Changes in inspiratory airway resistance

7
 Paw-peak increased but Plateau
pressure unchanged:
1. Tracheal tube obstruction
and kinking
2. Airway obstruction from
secretions
3. Acute bronchospasm

Rx: Suctioning and

Bronchodilators
8
 Changes in compliance
In this situation P-P gradient is fixid.
increasing compliance → plateau and peak pressures fall
decreasing compliance → plateau and peak pressures rise

9
 Paw-peak and Plateau pressure
are both increased:
1. Pneumothorax
2. Lobar atelectasis
3. Acute pulmonary edema
4. Worsening pneumonia
5. ARDS
6. COPD with tachypnea and Auto-PEEP
7. Increased abdominal pressure
8. Asynchronous breathing
10
 Decreased Paw-peak:

1.Inadequate gas supply, inadvertent change in

setting, system air leak, Tubing disconnection,
cuff leak, unintended extubation and failure of
the ventilator
Rx: Manual inflation, listen for leak

2. Hyperventilation: Enough negative intrathoracic

pressure to pull air into lungs may drop Paw-
Peak

11
Measurements

12
Measurements

13
P –T curve

At the start of inflation, the airway pressure immediately rises

because of the resistance to gas flow (A), and at the end of
inspiratory gas flow the airway pressure immediately falls by the
same pressure (A) to an inflexion point.

14
 P/T F/T V/T curves in
VCV

15
16
 Increase in Ppeak–Pplat gradient
• Increased airway resistance caused
by heat and moisture exchanger (HME)
• Patient biting endotracheal tube
• Kinked or twisted endotracheal tube
• Obstruction of endotracheal tube by
secretions, mucus, blood
• Bronchospasm
• Obstruction of lower airways
Schematic of two superimposed pressure-time curves
showing a small increase in peak inspiratory pressures
(Ppeak) with a greater increase in plateau pressures
(Pplat).
This is characteristic of decreased lung compliance
 Unchanged or decreased
Ppeak–Pplat gradient
• Pneumonia
• Atelectasis
• Mucus plugging of one lung
• Unilateral intubation
• Pneumothorax
• Pulmonary edema (noncardiogenic and
cardiogenic)
• Abdominal distention/pressure
Spontaneous Breathing

20
 Positive End Expiratory Pressure
• … is the pressure at the end of expiration

• Serial Elevated PEEP  P plateau and FRC

21
 1- Extrinsic PEEP
(applied PEEP by MV)
• 3 - 20 cm H2O and be started on 5 cm H2O
• It improves the oxygenation not CO2 removal
• It may be increased 3-5 cmH2O Q 10-15 min
• It has some side effects: biotraumas and
hemodynamic compromise

• What is the optimal PEEP?

1- increasing PEEP until a complication occurs
2- assessing P plateau

22
 Optimal PEEP

1. P-V curve monitoring

2. Cardiac Output monitoring and Venous Oxygen

Saturation

If SmvO2 decreases after PEEP application  Drop

C.O.
In this situation  PEEP and/or tidal volume
23
 P-V curve
Adequate PEEP Inadequate PEEP

24
 PEEP

25
 PEEP Disadvantages:
• 1. Decrease BP & CPP

2. Increase PCO2

3. because alveolar injury is often heterogeneous,

appropriate PEEP in one region may be
suboptimal in another and excessive in another

26
 2- Intrinsic PEEP
• …is incomplete alveolar emptying during expiration
due to air trapping
• Ventilator Factors: High inflation volumes, rapid
rate, low exhalation time
• Disease factors: Asthma, COPD (collapsed airway)
• And has some effects:
– Decreased C.O.
– Alveolar rupture
– increased work of breathing
27
 Int. PEEP
• Int. PEEP may be detected in two ways:

(1) evaluating the flow-time trace (exp. Flow not

returned to zero before next breath)

(2) disconnecting the patient from the ventilator and

listening for additional exhaled gas after an
exhalation has occurred.

28
 Pressure cycled

• Volume
cycled

29
30
 No absolute contraindications
 Loss of airway anatomy
Loss airway protection
 Respiratory and cardiac Failure
 Apnea / Respiratory Arrest
 Inadequate ventilation (acute vs. chronic)
 Inadequate oxygenation
 Eliminate work of breathing
 Reduce oxygen consumption
 Neurologic dysfunction
 Central hypoventilation/ frequent apnea
 Comatose patient, GCS < 8
 Inability to protect airway

31
32
 Control mechanisms
1. Spontaneous breathing (PSV)

2. Pressure targeted ventilation

3. Volume targeted ventilation

33
• Setting: FiO2 and PEEP

• Flow and f is dictated by patient

34
 Alters gas flow and volume  fixed preset airway
pressure (Paw) for the duration of a preset
inspiratory time (Ti )

 Advantage: fixed pressure  limit or eliminate

alveolar over-distention and barotraumas

 One problem: changes in compliance or resistance

with fixed Paw  variable received volume
35
 Deliver a preset volume of gas ( VT)  Paw is
variable

Advantage: delivery a constant VT

changes in compliance or resistance with fixed
volume  changes airway pressure

36
• There are no clinical outcome studies showing benefit
of one breath-targeting strategy over the other.

• Pressure-targeting provide a variable flow tends to

synchronize better with patient effort.

37
38
39
40
 Control Mode Ventilation
Continuous mandatory ventilation
Continuous mechanical ventilation
Controlled mandatory ventilation
 Intermittent Positive Pressure Ventilation (Dräger)

 …is a full support mode (machine breaths)

 All breaths are supported regardless of initiation of
breathing and can be set to VCV and PCV
 Used for: apneic patients, respiratory muscle
weakness and LV dysfunction
41
 (CMV/AC )
Sensitivity pressure  0.5 to 2 cm H2O (1-3
cm H2O Tintinalli)

The higher sensitivity  the greater work of

breathing

After spontaneous breath  the ventilator`s

timer resets from this time

42
 (CMV /AC)

CMV  preferred and most commonly used

initial mode for acute phase of respiratory failure
in ED

 but CMV :
1. Poor toleration in awake patients
2. Worsening of volume retention in COPD /
asthma
43
A/C mode

44
45
 SIMV (Dräger, Hamilton)
SIMV (VC) + PS (Maquet)
 VCV-SIMV (Puritan-Bennett, Respironics)
Volume SIMV (Viasys)
Intermittent demand ventilation

 IMV  combination of spontaneous vent. and AC

 IMV  is a partial support mode
 This ventilator mode provides breaths at a preset rate
(machine breath) similar to the AC mode
 Can be set to PCV and VCV
46
 (IMV / SIMV )
 But in spontaneous breath  only receive a spontaneous VT
with no support from the ventilator and has a high work of
breathing

 The synchronized version of IMV  coordination

spontaneous and machine breaths

 SIMV:
1. To prevent excess VT delivered (stacking)  decreased
hyperinflation, barotrauma
2. During exhalation from a spontaneous breath
exhalation compromised
47
48
49
50
 Assisted Spontaneous Breathing(Dräger)
Spontaneous mode(Hamilton, Puritan-Bennett)
Pressure support (Maquet)
CPAP (Respironic)
Pressure Support Ventilation (Viasys)
continuous positive-pressure breathing (CPPB )
EPAP

 Is a partial support mode

 Breathing control by the patient (spontaneous mode ) ,
and peak Paw control by machine (pressure targeted)

51
PSV

52
 PSV / ASB / CPAP

 Help the patient overcome the resistance of the

circuit  decreased work of breathing

 This is not useful in apnea

53
 CPAP / PSV / ASB

 CPAP  the least amount of support and used with IPPV

or NIPPV

Most commonly used in (COPD) , CHF and

obstructive sleep apnea with NIPPV ( via a tight-
fitting nasal or full face-mask)

54
 CPAP / PSV / ASB
 With IPPV  CPAP is typically used as a weaning
mode

 The CPAP level when transitioning from IMV/PSV or AC

mode should be the PEEP level that was being used

 Reducing the CPAP below the previous PEEP :

1. Loss of alveolar recruitment
2. Atelectasis
3. Hypoxia
4. Increased work of breathing
55
 CPAP / PSV

In partial support:

 CPAP range is from 0 up to 35 cm H20 pressure
 Some ventilators may deliver PSV that achieves a
greater range.
 The average starting point is:
10 cm H20
 Use PSV for approximation of spontaneous Vt and
the set Vt for mandatory breaths
56
 (CPAP) benefits

Eliminate the work of breathing

To aid in weaning from IMV-base ventilation

and is frequently part of a transition strategy
from IMV to CPAP

57
Breath type & examples

58
DRÄGER Evita 2 CMV

59
DRÄGER Evita 4 CMV

60
DRÄGER Evita 2 SIMV

61
DRÄGER Evita 4 SIMV

62
DRÄGER Evita 2 CPAP

63
DRÄGER Evita 4 CPAP

64
DRÄGER Evita 2 PCV

65
DRÄGER Evita 4 PCV

66
DRÄGER Evita XL SIMV

67
68
 1. Oxygen

 The fraction of inspired O2 (FiO2) is set in a range

from 21% (room air; not generally indicated) to
100%

 In the ED it is common to start at 100% FiO2 to

ensure adequate oxygenation and titrate the FiO2
down to nontoxic levels (FiO2< 60%) following the
SaO2 via the pulse oximeter (SaO2> 90%) during
first 72 h.
 some practitioners recommend using 95% O2 as the
upper limit of FiO2
69
 2. Inspiration : Expiration
(I:E) Ratio
• The normal I:E ratio in a spontaneously breathing,
non intubated patient is 1:4

• Intubated patients commonly achieve I:E ratios of

1:2

70
 3. Flow rate (Q )
• This is the rate of gas delivery (L/min).
• The range of flows that can be achieved by
current ventilation is from 10 to 160 L/min.
• Common flow settings are from 40 to 75 L/min.
• The higher the flow rate, the faster the ventilator
will reach its set volume or pressure.
• Start at Q=60 L/ min

• A faster flow rate  decreased ins. time

• A slower flow rate  decreased exp. time
71
 Flow-time diagram
VCV PCV

72
73
Initial ventilator setting

74
 Pressure triggering
• The sensitivity of the trigger can be adjusted by
changing the pressure drop required for
inspiratory cycling to be triggered, and this can
be set to a value between −1 cm H2O (very
sensitive) and −20 cm H2O (very insensitive)

• If the setting is too sensitive, minor fluctuations

in breathing circuit pressure (e.g. from cardiac
pulsations) can trigger the ventilator
inappropriately.
75
 Flow triggering
• The reduction in return flow that has to be
detected for triggering to occur can be
adjusted between 1 (very sensitive) and 10
(insensitive) L/min

• Flow triggering is considered to require less

work from the patient to initiate a breath and
therefore may enhance patient comfort and
reduce the work of breathing.
76
 Advanced modes
• BREATH TO BREATH
– Pressure-regulated volume control (PRVC)
– Auto flow
– Volume control plus (VC+)
– Adaptive pressure ventilation (APV)
– Variable-pressure control (VPC)
• WITHIN A BREATH
– Volume-assured pressure support ventilation (VAPSV)
– Pressure augmentation

77
 Other modes
• High Frequency
Ventilation
• Proportional assist
ventilation
• Airway Pressure Release
Ventilation (Bi-level
ventilation)  PCV
• T high : 4 – 6 s
T low : 0.2 – 1.5 s
• P high : up to 40 cmH2O
P low : 10 cmH2O
78
TUMS 79
TUMS 80
 Noninvasive Ventilation
• For prevention of invasive MV in selected patients

• No need to definitive airway control

• Candidates :
COPD, CHF, Asthma, hypoxia, DNR patients
and Immunocompromised patients

1. the airway must be patent,

2. the respiratory drive must be intact,
3. the patient must be cooperative
TUMS (i.e., awake and alert).81
82
• Serial assessment and close monitoring Q 30
min
• ABG Q 1-2 h
• Contraindications:
– Near arrest
– Severe GIB
– Anatomic defect of face
– Up airway obstruction
– AMS
– Risk of aspiration and defect in secretion clearance

83
Nasal mask

TUMS 84
 Advantages of NIV
The potential benefits of NIV over MV are:

1. a decrease in potential airway injury

2. decrease in VAP
3. probably a shorter length of stay
4. Eating and speech reserved

TUMS 85
 Disadvantages of NIV

1. Pulmonary baro-trauma (volu-trauma)

2. pressure necrosis of the facial skin, subcutaneous tissue
and musculature and patient discomfort
3. aerophgia  gastric dilation  vomiting and aspiration
4. hemodynamic compromise

TUMS 86
TUMS 87
 ventilation
Bi-level

Bi-level ventilation.
A: Baseline pressure cycles between Plow and Phigh with spontaneous, unsupported,
patient breaths during high and low phases.
Transition from low to high phase is synchronized to the patient’s inspiration, and
transition from high to low phase is synchronized to patient’s expiration.
B: As in A, but now inspiratory efforts during the Plow phase trigger support (Psupp).
 ventilation
Bi-level

Bi-level ventilation.
C: As in A, but now inspiratory effort during both Plow and Phigh phase trigger support which is targeted to the
same absolute support pressure (Psupp).
If Phigh is greater than Psupp, patient effort during Phigh becomes unsupported.
D: As in A, but now inspiratory effort during both Plow and Phigh phase trigger support which is set specifically for
each phase,relative to the baseline pressure of the phase.
 Approach to NIPPV

• In hypoxemia:
EPAP + 2 cmH₂O and fix interval IPAP

• In hypercapnia:
IPAP + 2 cmH₂O and EPAP= 40% IPAP

TUMS 90
 High flow nasal cannula
• … can deliver warm
and humidified air up
to 40 L/min

91
TUMS 92
 1. Severe Acute Lung Injury and ARDS
• Preferred PCV
• consider permissive hypercapnia.
If able to achieve P02> 60 mm Hg on FiO2<60%, the
PCO2 may be allowed to be >40 mm Hg if pH> 7.25.
if needed, use NaHCO3

• Tv  6 – 8 ml / kg
• F  20 – 25 / min
• PEEP  8
• Monitor P plateau: if > 30 cm H2O  Tv : 4 ml/kg
TUMS 93
 2. Severe Asthma and COPD
• The defect is decreased gas flow.
• In conventional ventilation use higher flow rate and
lower respiratory rate to allow more time for
exhalation.
• Tv  5 -8 ml / kg
• F  8 – 10 / min
• Q 80 l/min
• PEEP  5 (50 - 80% intrinsic PEEP)
• Detection of intrinsic PEEP with wean and chest
compression
• Optimal P plateau < 30 cmH2O
TUMS 94
Monitoring of treatment in asthma

95
 3. Pulmonary edema

• NIPPV is preferred
• If the patient is intubated  PEEP is useful
• But in hypotensive patients  min. PEEP
with continuous evaluation

TUMS 96
 5. Traumatic brain injury

• Do not lower PC02 < 35 mm Hg, as it may induce

severe cerebral vasoconstriction and lead to cerebral
ischemia.
• The goal is PC02: 35-40 mm Hg.
• Acceptable to hyperventilate for a patient with an
acute herniation syndrome as a bridging maneuver
for definitive therapy.

TUMS 97
General Guidelines for Initial Invasive Ventilator Settings in Various
Clinical Settings / Rosen`s EM
PEEP (cm
Mode FIO2 (%) VT (mL/kg) F / min I/E H2O)

CMV, A/C, IMV,

Overdose in
SIMV 95 8–10 10–12 1:2 0–5
healthy patient
Status CMV, A/C, IMV,
asthmaticus SIMV 95 5–10 8–12 1:4 2.5–10
COPD CMV, A/C, IMV,
exacerbation SIMV 95 5–10 10–12 1:3–1:4 2.5–10
pulmonary
CMV, A/C, IMV,
edema SIMV 95 8-10 10–12 1:2 2.5–15
ARDS CMV, A/C, IMV,
SIMV 95 6-8 20-25 1:2 2.5-10
Hypovolemic CMV, A/C, IMV,
shock SIMV 95 8-10 - 1:2 0-5
 complications
• Pneumothorax
• Ventilator induced lung injury
• Hemodynamic instability
• Difficult trigger ventilation
• Auto-cycling (seizure, shivering)
• Outstripping and double cycling (demand over Vt)
• Straining over the ventilator (demand over Q)
• Coughing
• Failure to MV

99
Approach to res. distress 100
101
 Indications for extubation
No weaning parameter completely accurate when used alone

Numerical Parameters Normal Weaning

Range Threshold
P/F > 400 > 200
• Clinical parameters Tidal volume 5 - 7 ml/kg 5 ml/kg

• Resolution/Stabilization of disease Respiratory rate 14 - 18 breaths/min < 40 breaths/min

process Vital capacity 65 - 75 ml/kg 10 ml/kg

Minute volume 5 - 7 L/min < 10 L/min
• Hemodynamically stable
• Intact cough/gag reflex
Greater Predictive Normal Weaning
• Spontaneous respirations Value Range Threshold
NIF (Negative > - 90 cm H2O > - 25 cm H2O
• Acceptable vent settings Inspiratory Force)
• FiO2< 40%, PEEP < 8, PaO2 > 75, pH RSBI (Rapid Shallow < 50 < 100
> 7.25 Breathing Index)
(RR/TV)
Marino P, The ICU Book (2/e). 1998.
 Criteria :
• The cause of respiratory failure is
improving or has been eliminated,
• FiO2 < 0.40
• PEEP < 8cm H2O
• No pressors other than
dopamine at <5 μg/kg / min or
Epinephrine or NorEpi. at < 0.05 µg /kg /
min.
TUMS 103
weaning
 Normal Adult Threshold for
Parameter
range weaning
PaO2/FiO2 >400 200
Tidal Volume 5-7 ml/kg 5 ml/kg
RR 14-18 /min <40 /min
Minute Vent. 5-7 L/min <10 L/min
Vital
65-75 ml/kg 10 ml/kg
capacity
Peak >90 cmH2O (F)
Inspiratory 25 cmH2O
Pressure >120 cmH2O (M)

RSBI (f/Vt) <50

TUMS
/L <105 /L
 The Problem Wean
• RAPID BREATHING  1
• 1. Check Vt
Low Vt  Resume vent. support
Vt not low  2
• 2. Check PaCO2
PaCO2 decreased  sedate (anxiety)
PaCO2 not decreased  Resume vent.

TUMS 106
• ABDOMINAL PARADOX :
Inward displacement of the diaphragm during
inspiration is a sign of diaphragmatic muscle
fatigue
• HYPOXEMIA : May be due to low C.O.
• HYPERCAPNEA:
– Increase in PaCO2-PetCO2
= increase dead space ventilation
– Unchanged gradient: Respiratory muscle fatigue or
enhanced CO2 production

TUMS 107
Weaning

108
 Tracheal Decannulation
• Successful weaning is not synonymous with tracheal
decannulation
• If weaned and not fully awake or unable to clear
secretions, leave ETT in place
• Tracheal decannulation increases the work of
breathing due to laryngeal edema and secretions
• Do not perform tracheal decannulation to reduce
work of breathing

TUMS 109
 Inspiratory Stridor
• Post extubation inspiratory stridor is a sign of severe
obstruction and should prompt re-intubation
• Laryngeal edema (post-ext) may respond to aerosolized
epinephrine in children
• Steroids have no role
• Most need reintubation followed by tracheostomy

TUMS 110
TUMS 111
TUMS 112
 Case 1

• An l8-year-old otherwise healthy 60-kg female

presents with an overdose of benzodiazepines.
• She requires intubation for airway protection and
ventilatory support.
• There is no evidence of aspiration or an intrinsic
lung problem.

TUMS 113
 With VCV setting

Target Vm = 7.2 L / min

It is reasonable to assume a normal need for
Vm since she has no evidence of
hypoperfusion or infection, and she has not
ingested an medications known to cause a
metabolic acidosis that would require a
higher Vm to buffer by induced hypocarbia.

TUMS 114
 Dräger evAita 2

Patient data

Ventilator setting

Alarm setting

TUMS 115
 Vt and f

• F= 12 /min
• Vt = 600 mL (7-10 mL/kg)

• This setting will guarantee the desired Vm even

if the patient continues to develop respiratory
depression from the benzodiazepine ingestion.

TUMS 116
 Pressure Support Ventilation.

• Initiate PSV at 10 cm H20 pressure, and then

titrate up or down to achieve a spontaneous
breath Vt approximately equal to that of the set
Vt.

TUMS 117
• Gas Delivery Waveform:
Begin with a decelerating waveform.

• Maximal Inspiratory Flow :

Set the initial Q at 60 L/min.
lower Q(Q = 50 L/min) in hypoxemia
higher flow (Q = 70 L/min) in exhalation
obstruction (e.g. COPD), then evaluate the
resultant Paw-peak.
TUMS 118
• If the Vt is appropriate, reduce the flow rate by 5
L/min and re-evaluate; repeat if necessary.

• If the Q is reduced to 40 L/min and the Paw-peak

remains high, :

1) the Vt is, in fact, too large for the available lung

mass,
2) there is a tube obstruction (partial)
3) the patient has a pleural space occupying
disorder (pneumo-, hemo-, hemopneumo-, or
hydro-thorax),
4) the patient requires a different mode
5) there is a ventilator dysfunction
TUMS 119
 Order writing
1 2
Then titrate PSV to achieve Vt
SIMV spont. 600 ml
f : 12/ min
FiO2 : 95% • ABG 20 min later
PEEP : 5 cm H2O
ASB / CPAP / PSV : 10 cm
H2O
Flow : 60 L/min Ramp
wave

TUMS 120
 The same patient with PCV setting
 Vm = 7.2 L/min  FiO2= 95%
 Mode = ( in E4 , 2 )  PSV =10 cm H2O
PCV+ SIMV, .PCV.  PEEP=5 cm H2O
PSV. ASB
 Q = 160 L/min  PC
( devise adjust the Q in =[(Paw peak) – PEEP] ×2/3
response to the = (35 – 5)× 2/3
patient`s breath.) =20 cm H2O
 Wave = ramp
 F = 12/ min  (Paw Peak )
=PC+ PEEP
TUMS
=25 121
 Order writing
1 2
SIMV PEEP :5 cm H2O
f : 12/ min PSV : 10 cm H2O
PC : 20 cm H2O Q : max (160) L/min
Ti : 1 s Wave : ramp
FiO2 : 95 %

ABG 20 min later

122
 Case 2

• A 45-year-old, 70-kg male presents with high fevers,

cough, and shortness of breath.
• The ED portable chest film demonstrates bilateral
infiltrates as well as lower lobe air bronchograms.
• While awaiting admission to the hospital for presumed
community-acquired pneumonia, the patient develops
hypoxia, suffers respiratory failure, and requires urgent
intubation.

TUMS 123
• Mode : SIMV-As before, allow the patient to breathe
spontaneously when the short acting neuromuscular
blockers or heavy sedative (e.g., etomidate, fentanyl,
midazolam) used to facilitate intubation wears off.

• Target Vm :Given the likely acidosis, this patient's Vm

needs to exceed the lower limit of normal value.
• Thus, a target of 9.8 L/minute is a 40% increase above the
baseline .

TUMS 124
• initial f= 14 / min
• Vt = 700 ml

• One must evaluate the resultant Paw-peak after starting

at this setting.

• One may also need to reduce the tidal volume and

increase the rate if the Paw-peak is high and no other
mode of ventilation is available.

TUMS 125
• Fi02 : Begin with FiO2 :95% then titrate.
• PEEP : ≥5 (to maintain FRC and alveolar
recruitment with V/S consideration )
• Flow:
• A longer Ti is ideal for alveolar recruitment
and a slow flow rate will complement the
decelerating waveform and further prolong
the Ti.
• Then start with a Q of 50 L/min

TUMS 126
• Start with a higher PSV because the pulmonary compliance
is less than the normal lungs.

• Initiate PSV at 15 cm H20 and titrate to achieve similar Vt

with the machine and spontaneous breaths.

• In PCV : the same MODE & Vm …

• Only set the Ti & PC (longer Ti)

• Then reevaluate the patient`s condition

TUMS 127
TUMS 128