Ventilator Management Orders

ForConsented Organ Donors

______BiLevel Set Up

  • Initial FiO2 40%
  • Rate 8 - 20
  • PEEP Low 10 – 18 cm H2 : Adjust to maintain PaO2 > 100mm Hg on FiO2 40%
  • PEEP High to obtain Vt 6 - 10 ml/kg ideal body weight
  • Adjust TH (time at PEEP high) to maintain an initial I:E 1:1
  • Monitor closely, maintaining PIPs < 38 cm H2O
  • Keep I:E ratio as close to 1:1 as possible while avoiding Auto peep

BiLevel Ventilation Changes – as indicated per ABG’s

  • To increase ventilation (ie decrease PaCO2) while maintaining MAP
  • Increase rate: Adjust TH (time at PEEP High) to maintain 1: 1 ratio
  • OR Increase PEEP High keeping Vt 6-10 ml/kg ideal body weight
  • To decrease ventilation (ie increase PaCO2) while maintaining MAP
  • Decrease rate: Adjust TH (time at PEEP High) to maintain 1:1 ratio
  • OR Reduce PEEP High keeping Vt 6-10 ml/kg ideal body weight
  • To increase oxygenation (ie increase PaO2) Keeping FiO2 at 40%
  • Raise Peep Low and raise the PEEP High by the same amount keep PIP’s < 38
  • ORIncrease the I:E ratio (lengthen the TH)

DO NOT inverse I:E ratio without speaking to LifeShare Coordinator

______Pressure Control Set Up (for Transport Ventilators or when BiLevel is not available)

  • Initial FiO2 40%
  • Rate 8 – 20
  • PEEP 10 – 18 cm H20: Adjust to maintain PaO2>100 mm Hg on FiO2 40%
  • Inspiratory Pressure set to obtain Vt 6 - 10 ml/kg ideal body weight
  • Adjust Inspiratory time to maintain an initial I:E 1:1
  • Monitor closely, maintaining PIPs < 38 cm H2O
  • Keep I:E ratio as close to 1:1 as possible while avoiding Auto peep

Pressure Control Ventilation Changes as indicated per ABG’s

  • To increase ventilation (ie decrease PaCo2) while maintaining MAP
  • Increase rate: Adjust I time to maintain 1:1 ratio
  • OR Increase Inspiratory pressurekeeping Vt 6 - 10 ml/kg ideal body weight
  • To decrease ventilation (ie increase PaCO2) while maintaining MAP
  • Decrease rate: Adjust I time to maintain 1:1 ratio
  • OR Decrease Inspiratory pressure keeping Vt 6-10 ml/kg ideal body weight
  • To increase oxygenation (ie increase PaO2) keeping FiO2 at 40%
  • Increase PEEP keeping the PIP’s<38

DO NOT inverse I:E ratio without speaking to LifeShare Coordinator

______Respiratory Orders

  • Use a heated circuit and DO NOT disconnect patient from ventilator without LifeShare notification
  • Patient to always be transferred on the ventilator
  • Chest PT and Pulmonary Toileting
  • Module or manual rotation every 15 minutes
  • Percussion for 15 minutes every 2 hours, suctioning each time
  • If hemodynamically tolerated, place in trendelenburg for percussion then suction and return HOB to 30degrees

Oxygen Challenge (complete as requested)

  • Maintain BiLevel or PCV mode during challenge
  • Increase FiO2 to 100%
  • Decrease PEEP Low to 5 cm H2O
  • BiLevel - decrease PEEP High to maintain Vt prior to O2 Challenge
  • Pressure Control - adjustinspiratory pressure to maintain Vt prior to O2 Challenge
  • Maintain setting for 15 minutes
  • Draw ABGthen return to previous settings ventilator settings
  • Verbally report ABG’s to LifeShare Coordinator and make changes as indicated

Signature:______per LifeShare Standing Orders/Protocol

LifeShare Organ Recovery Coordinator

Date:______Time:______UNOS:______

Reviewed Date 02/28/2012