REBEL Core Cast 146.0–Ventilators Part 4: Setting up the Ventilator

Ventilator management requires tailored strategies based on patient physiology to ensure effective gas exchange while preventing lung injury. For patients with normal lung function, Volume Assist Control with a tidal volume of 6–8 mL/kg and a standard rate of 14–16 breaths per minute provides a baseline. Severe metabolic acidosis, such as in DKA, necessitates higher minute ventilation, achieved through increased tidal volumes (8 mL/kg) and elevated respiratory rates to compensate for the metabolic deficit. Conversely, obstructive lung disease like asthma demands lower respiratory rates to allow sufficient expiratory time, preventing auto-PEEP and associated hemodynamic compromise. In cases of refractory hypoxemia, an open-lung strategy utilizing optimized PEEP and reduced tidal volumes (4–6 mL/kg) maintains plateau pressures below 30 cmH2O, minimizing barotrauma risk while improving oxygenation.