Ventilator Settings

CRNA Study Suite · Lung-Protective Ventilation
Fluid LA Max Dose Ventilator
Patient
Gas Exchange (optional)
Mild P/F: 200-300
Moderate P/F: 100-200
Severe P/F: <100
Recommended Settings
PBW
--
kg
Tidal Volume (6 mL/kg)
--
mL
Tidal Volume (8 mL/kg)
--
mL
Target PEEP
--
cm H₂O
Plateau Pressure
≤30
cm H₂O
P/F Ratio
--
ARDS?
Calculation Breakdown
1. Predicted Body Weight (PBW)
--
--
PBW = -- kg
(Fernandez-Bustamante & Bucklin, 2024, p. 3819)
2. Lung-Protective Tidal Volume
TV = 6-8 mL/kg × PBW (not IBW, not TBW)
--
Target TV = -- mL
(Heiner, 2023, p. 666; Krogh, 2023, p. 1105)
3. PEEP Recommendation
Standard GA: 5-10 cm H₂O
--
Target PEEP = -- cm H₂O
(Heiner, 2023, p. 666)
4. Expected A-a Gradient for Age
Age-expected A-a = (Age / 4) + 4 mmHg
--
Expected A-a = -- mmHg
(Heiner, 2023, p. 631)
7. Reference Targets
Lung-protective ventilation bundle (Nagelhout Ch 29, p. 666)
• TV 6-8 mL/kg PBW
• Plateau pressure ≤ 30 cm H₂O
• Driving pressure (Pplat − PEEP) ≤ 15 cm H₂O (Park et al., Anesthesiology 2019, p. 1047)
• Compliance (Cstat) = TV / (Pplat − PEEP); normal 60-100 mL/cm H₂O
• PEEP titration to optimize recruitment
• Recruitment maneuver: 30 cm H₂O × 10 sec (or 40 × 40 strategy)
References

Heiner, J. S. (2023). Respiratory anatomy, physiology, pathophysiology, and anesthesia management. In S. Elisha, J. S. Heiner, & J. J. Nagelhout (Eds.), Nurse anesthesia (7th ed., pp. 614-679). Elsevier.

Krogh, M. A. (2023). Obesity and anesthesia practice. In S. Elisha, J. S. Heiner, & J. J. Nagelhout (Eds.), Nurse anesthesia (7th ed., pp. 1092-1108). Elsevier.

Fernandez-Bustamante, A., & Bucklin, B. A. (2024). Anesthesia and obesity. In B. F. Cullen, M. C. Stock, R. Ortega, C. W. Connor, & N. Nathan (Eds.), Barash, Cullen, and Stoelting's clinical anesthesia (9th ed., pp. 3814-3876). Wolters Kluwer.

How this works

Tidal volume by ideal body weight

Lung protective tidal volume is dosed to predicted (ideal) body weight, not actual weight, because lung volume tracks height rather than adiposity (Hallman, 2024, p. 4828). IBW for men is 50 + 2.3 x (height in inches - 60); for women, 45.5 + 2.3 x (height in inches - 60) (Hallman, 2024, p. 4828).

Starting settings for the OR

The vault's intraoperative protective ventilation table sets tidal volume at 5 to 7 mL/kg predicted body weight, a starting rate of 6 to 12 breaths/min titrated to PETCO2, an I:E ratio of 1:2, and PEEP of 5 to 8 cm H2O (Tharp & Dosch, 2023, pp. 276-280). Keep plateau pressure below 28 and driving pressure below 16 cm H2O, and FiO2 as low as possible (avoid above 0.8) to hold SpO2 at 88 to 95% (Tharp & Dosch, 2023, p. 277).

References

Tharp, D. L., & Dosch, M. P. (2023). Anesthesia equipment. In Elisha, Heiner, & Nagelhout (Eds.), Nurse anesthesia (7th ed., pp. 246-290). Elsevier.