Setting the Ventilator

The application of mechanical ventilation is a common life-saving intervention in the critical care transport environment. While the fundamental principles of mechanical ventilator support have changed slightly over decades, poor ventilator management can cause ventilator-induced pulmonary and extrapulmonary injury that may not immediately be apparent but greatly impact the patients’ outcome. When setting the ventilator, clinicians must consider the patient's pathologies in selecting the mode, tidal volume, respiratory rate, positive end-expiratory pressure, inspiratory time/I:E ratio, and fraction of inspired oxygen to protect pulmonary parenchyma and maintain adequate gas exchange. Intubated and mechanically ventilated patients require close monitoring for hemodynamic changes and to ensure that the selected settings support their physiologic needs. Clinicians should be knowledgeable about techniques that optimize ventilatory parameters and thoroughly understand the secondary pathophysiological changes associated with positive-pressure ventilation.