Set safe initial ventilation for any intubated adult, understand volume, pressure and spontaneous modes, troubleshoot alarms and sudden deterioration with DOPES, read basic waveforms to detect asynchrony and auto-PEEP, liberate patients with daily SAT-SBT, and time tracheostomy sensibly.
6 topics
- 01
Initial ventilator settings
Calculate predicted body weight from height, start volume control at 6-8 mL/kg PBW, PEEP 5-8, rate to match minute ventilation need, FiO2 to SpO2 92-96%, then check plateau and driving pressure and an ABG at 30 min.
9 stepsAlgorithmNew - 02
Ventilator modes made simple
Every mode is defined by what the machine controls (volume or pressure), what triggers a breath (time or patient) and what ends it (volume, time or flow). Use assist-control early, pressure support when the patient breathes well, and know what to monitor for each.
6 stepsAlgorithmNew - 03
Alarms and sudden deterioration (DOPES)
If a ventilated patient suddenly desaturates or becomes hypotensive, take them off the ventilator and hand-bag with 100% O2, then work through DOPES: Displacement, Obstruction, Pneumothorax, Equipment, Stacking.
8 stepsAlgorithmNew - 04
Ventilator graphics, auto-PEEP and asynchrony
Read the pressure, flow and volume waveforms to spot auto-PEEP (expiratory flow not returning to zero), ineffective triggering, double triggering, and flow starvation, and fix each with a specific setting change.
7 stepsAlgorithmNew - 05
Liberation: daily SAT and SBT
Screen every patient every morning. Pair a spontaneous awakening trial with a spontaneous breathing trial (30-120 min, pressure support 5-8 or T-piece). Extubate those who pass and can protect the airway; support high-risk patients after extubation.
7 stepsAlgorithmNew - 06
Tracheostomy: timing and care
Consider tracheostomy when ventilation is likely to be prolonged (usually after 7-10 days or earlier in severe neurological injury). Early routine tracheostomy does not improve survival. Know emergency management of a displaced or blocked tracheostomy.
5 stepsAlgorithmNew
Drugs in this module
Doses written for this module's context. The same drug may read differently in another module.
Propofol
GABA-A agonist sedative
Propofol
GABA-A agonist sedative
- Indications
- Light sedation for ventilated patients; allows daily sedation interruption.
- Adult dose
- 0.5-4 mg/kg/h (≈ 5-50 mcg/kg/min). Avoid > 4 mg/kg/h for > 48 h.
- Preparation (India)
- 1% (10 mg/mL) 20 mL and 50 mL vials; run undiluted in a 50 mL syringe.
- Cautions
- Hypotension; hypertriglyceridaemia (check TG every 48-72 h); propofol infusion syndrome (acidosis, rhabdomyolysis, arrhythmia) with high doses.
Fentanyl
Opioid analgesic
Fentanyl
Opioid analgesic
- Indications
- Analgesia-first sedation in ventilated patients.
- Adult dose
- Infusion 0.5-2 mcg/kg/h; bolus 25-50 mcg as needed.
- Preparation (India)
- 50 mcg/mL; 1000 mcg in 50 mL = 20 mcg/mL (or 500 mcg in 50 mL = 10 mcg/mL).
- Cautions
- Accumulates with prolonged infusion; ileus; chest wall rigidity with rapid boluses.
Module references (10)
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