Ventilator formulas and review
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Ventilator Formulas and Review. http://www.drugbank.ca/drugs/DB01001 MOA of all drugs. A-a Gradient also know PF ratio. A-aDo2: A-a gradient, norm 5-10 mmHg on .21, 30-60 on 100%, >350mech support, <350 weaning.

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A a gradient also know pf ratio
A-a Gradient also know PF ratio

  • A-aDo2:A-a gradient,

  • norm 5-10 mmHg on .21, 30-60 on 100%, >350mech support, <350 weaning.

  • Represents potential to Oxygenate vs. the amount of O2 in the artery. Every 50mmHg is approx. 2 percent shunt above norm of 2-5%

  • Increased A-a= SHUNT


A a ratio
a/A ratio

  • a/A ratio:PaO2/PAO2 norm is 90%, >35%weaning, reflects efficiency of oxygenation as a percentage, <74% shunt, V/Q mismatch or diffusion defect


Anion gap
Anion Gap

  • Anion Gap= the difference in the measured cations and the measured anions in serum, plasma, or urine.

  • Used to assess Metabolic Acidosis or alkalosis, normal around 8-16 mEq/L. Use MUDPILES to determine cause of metabolic acidosis (high gap)

  • = ( [Na+] ) − ( [Cl−]+[HCO3−] ) without potassium

  • = ( [Na+]+[K+] ) − ( [Cl−]+[HCO3−] ) with potassium


CaO2

  • CaO2:norm 20 vol%

  • (Hbx1.34)SaO2 + (PaO2x.003) total amount of O2 carried in 100ml of blood, combined content of O2 carried on Hb and dissolved in plasma,

  • (can be reduced by <Hb, anemia or <CO)


CvO2

  • CvO2:(Hb x 1.34)SvO2 + (PvO2 x .003)

  • norm is 15 vol%, represents the value of O2 in blood returning to the right side of the heart after tissues have oxygenated.

  • C(a-v)O2 = arterial to mixed venous oxygen content difference

  • Determines how well the tissues take up O2


Oxygen consumption
Oxygen Consumption

  • VO2:O2 consumption,

  • norm is 250mL/O2/L/min,

  • [C(a-v)O2 x QT] x 10, the amount of O2 consumed by the body per liter of blood per minute.


Tube compliance
Tube compliance

  • Ct:Tube compliance aka compressible volume, volume lost to pt circuit, approx 3ml/cmH20 x PIP, deduct from VT to find actual delivered tidal volume. VT-(PIP x 3) equals actual VT.

  • Ex: Vt 550 – (25 x3) = 475


Time constant
Time Constant

  • Time Constant: The given % of a passively exhaled breath of air will require a constant amount of time to exhale

  • Depends on the resistance and compliance of the lung

  • TC= R x C (in liters)


Time constant1
Time Constant

  • TC:Time constant, (Raw x CS)e,

  • where e represents volume exhaled as a percent,

  • 1 is 63%,

  • 2 is 86%,

  • 3 is 95%

  • 5 is 100% exhaled.

  • TC <3 leads to air trapping.


DO2

  • DO2:O2 Delivery, (CaO2 x CO) x 10, norm is 1000mL/O2/min

  • The ability of oxygen to tissues based on cardiac output and Hb


I e calculations
I:E Calculations

  • I-time = Inspiratory Time,

  • E-time = Expiratory time,

  • TCT= total cycle time (I +E)

  • I-time when compared to E-time will always be a 1: something ratio.

  • Respiratory rate = 60 /TCT

  • EXAMPLE: Calculate I:E ratio, rate and TCT if I-time is 1.2 seconds and E-time is 3 seconds.

  • TCT = 1.2+ 3 = 4.2

  • Rate = 60/4.2 =14

  • I:E = TE/TI = 3/1.2 = 2.5, (I:E is 1:2.5)


I e calculations1
I:E Calculations

  • I-time = Inspiratory Time,

  • E-time = Expiratory time,

  • TCT= total cycle time (I +E)

  • I-time when compared to E-time will always be a 1: something ratio.

  • Respiratory rate = 60 /TCT

  • Example: The ventilator is set at 12 breaths per minute with an IE ratio of 1:3. How many seconds for inspiratory time?

  • Seconds per breath = 60 divided by 12 = 5 seconds

  • TI=5/(1+3) =5/4=1.25 seconds


I e calculations2
I:E Calculations

  • Example: The ventilator is set at 12 breaths per minute with an IE ratio of 1:3. How many seconds for inspiratory time?

  • Seconds per breath = 60 divided by 12 = 5 seconds

  • TI=5/(1+3) =5/4=1.25 seconds

  • Since I/E = 1:3, the expiratory time = 1.25 • 3 = 3.75 seconds

  • Note: 1.25 + 3.75 = 5 seconds (the number of seconds per breath in this case.) ( a breath equals inspiration + expiration)


Flow

  • Flow = VE x (I+E)

  • Example: Calculate flow given:

  • VT 600

  • Rate 12

  • IT 1.5

  • ET 3

  • 600 x 12 = 7.2 L x (1.5 +3) = 32 L


Suction catheter to et tube size
Suction Catheter to ET tube size

  • ETT size -2 x2

  • 8.0 ETT

  • (8-2)2 = 12 French


PaW

  • Mean Airway pressure (Paw): ½ (PIP-peep) (TI/TCT) + PEEP

  • Average amount of pressure throughout the TCT

  • AKA: Pmean, MAP, MAWP, PAW


Calculation of ve for desired paco2
Calculation of VE for desired PaCO2

  • VE = actual VE x actual PaCO2

    desired PaCO2

  • New rate = Current rate x actual PaCO2

    desired PaCO2

  • New Vt = Current Vt x actual PaCO2

    desired PaCO2


Calculation of ve for desired paco21
Calculation of VE for desired PaCO2

  • Example: Calculate the new set rate for a patient,

  • Current set rate: 12

  • PaCO2 on ABG 48

  • Desired PaCO2=40

  • New Rate = 12 x 48 / 40 = 14.4 (14)


Calculation of ve for desired paco22
Calculation of VE for desired PaCO2

  • Example: calculate the new VT for a patient with:

  • Current VT = 500

  • PaCO2 on ABG 55

  • PaCO2 desired 40

  • New Vt = 500 x 55 = 687.5 (688)

    40


Calculation of ve for desired paco23
Calculation of VE for desired PaCO2

  • Example: Calculate new VE for a patient with:

  • Current VE = 12

  • PaCO2 on ABG 60

  • Desired PaCO2 40

  • VE = 12 x 60 = 18

    40


Desired fio2
Desired FIO2

  • Desired FIO2 = (desired PaO2)(known FIO2) / known PaO2

  • Ex: Calculate the desired FIO2 for a patient with:

  • PaO2 on ABG 50

  • Current FIO2 30%

  • Desired PaO2 60

  • 60 x 0.30/ 50 = 36%


Cardiac output
Cardiac Output

  • Cardiac Output (CO) = amt of blood ejected from the heart per minute

  • CO= Stroke Volume X heart rate normal 4-8 L/min

  • QT = cardiac output

  • Cardiac Index (CI)= amount of blood pumps per minute based on body weight CI= CO/BSA, normal 2.4-4 L/min


Shunt equation
Shunt Equation

  • QS/QT:Pulmonary Shunt equation

  • (CcO2-CaO2)/(CcO2-CvO2)

  • Norm 2-3%,

  • >20% vent indication,

  • <20% weaning,

  • >30% is life threatening.

  • Measures % of QT not exposed to ventilation, shunts caused by atelectasis, edema, pneumonia, pneumothorax, obstructions

  • CcO2: Content of pulm capillary blood oxygen at 100% FIO2, (Hbx1.34)1 + (PAO2x.003) used in shunt equation


Spontaneous vt
Spontaneous VT

Total Ve (given from vent) –(VT mech x f mech)/ f spont (total rate – mech rate set)

SPONT VOLUME: 8.1 -5.6/10=250 ml

  • Measured when machine in SIMV mode, represents what the patient is actually breathing on his/her own.

  • GOAL is 5-7 ml/kg, adjust PSV to achieve this

  • EX: Pt on SIMV 8, total rate is 12, Set VT 500, Ve 8.0

  • 8 –(4) /4 = 1000 ml


Total ve
total Ve

  • VE total:(VT mech x f Mech) + (VT Spont x f spont)

    Calculated when patient is in SIMV mode

    Example:

    VT mech 700 ml, f mech 8, VT spont 250 ml, f spont 10

    Total Ve –(VT mech x f mech)/ f spont

    SPONT VOLUME: 8.1 -5.6/10=250 ml


Vital capacity
Vital Capacity

  • VC:Vital capacity, 65-75 mL/kg, <10mL/kg indicates support, 10-15 mL/kgweaning

  • Maximum inhalation followed by a maximum exhalation

  • Measured by a Wright Respirometer


RSBI

  • RSBI:Rapid shallow breathing index,

  • RR/VT, <105 weaning

  • must be calculated during spont breathing, press support reduces predictive value


MIP

  • MIP/NIF:Max Inspiratory Press, norm -80 - -100, > -20 support indicated, <-20 weaning (remember that negative numbers are larger as they become less, -25 < -20)


Hemodynamics
Hemodynamics

  • PAP:pulmonary artery pressure, norm 25/10 (20-35/5-15), >35/15 is inconsistent with weaning, pulm hypertension, left vent fail, fluid overload

  • PCWP:pulmonary artery wedge pressure, norm 5-10 mmHg, >18 is inconsistent with weaning, left vent failure, fluid overload

  • CVP:central venous pressure, norm 2-6 mmHg, 2-6 weaning


Plateau pressure
Plateau Pressure

  • Plateau pressure: The amount of pressure held in the lung during a brief inspiratory pause. This is used to calculate static compliance. The higher this number the worse the patients compliance as it represents distending pressure. Typically less than PIP, but more than MAP.


Peak inspiratory pressure
Peak Inspiratory Pressure

  • Maximum pressure reached during a positive pressure inspiration

  • Keep lower than 40 cmH2O

  • Increased with:

    • Secretions

    • Bronchospasm

    • Decreasing Compliance

    • Increased RAW

    • Asynchrony/fighting vent


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