Top Ventilation Strategies for Every ICU & ED Scenario

Securing an airway is just the beginning—tailoring your ventilation strategies can make or break outcomes in ARDS, neuro patients and obstructive lung disease. Use this guide to dial in the right parameters in seconds.

Ever stared at your ventilator knobs and thought, “What’s the right setting again?” You’re not alone. Whether you’re managing stiff ARDS lungs, protecting a head-injured patient, or wrestling with COPD, these cheat-sheet settings will have you covered in seconds.

Basic Adult Settings

Start here on every new patient:

Mode: Volume- or pressure-controlled (go with your unit’s default)
VT: 6–8 mL/kg predicted body weight (“think 6” if you can’t remember)
RR: 12–16 bpm (just enough to keep them comfy)
PEEP: 5–8 cmH₂O (titrate to keep SpO₂ 92–96 %)
FiO₂: 100 % to start—then dial down to your SpO₂ target

Pro tip: Always jot down PBW on your chart so your VT math’s locked in.

ARDSNET Low-VT Protocol

Stiff lungs need extra love:

Why? Smaller volumes spare you from ventilator-induced lung injury.

Neuroprotective Ventilation

Your brain-injured patient can’t handle big swings:

PaCO₂: 35–40 mmHg (no wild hypocapnia or hypercapnia)
PaO₂: Aim 100–120 mmHg—too much O₂ can hurt, too little starves
PEEP: Keep low (around 5 cmH₂O) so you don’t spike ICP
Head tilt: Elevate 30° for better venous drainage

Remember: abrupt CO₂ shifts can raise ICP—titrate slowly.

Obstructive Lung Disease (COPD / Asthma)

Prevent breath-stacking disasters:

Mode: Pressure support or PRVC
VT: 6–8 mL/kg—still your friend
I:E ratio: 1:3 or 1:4 (long exhale = less auto-PEEP)
RR: 8–12 bpm—give them time to breathe out
PEEP: 0–5 cmH₂O (minimal to avoid trapping)
Rescue: Salbutamol neb 5–10 mg via circuit

Tip: Watch your flow waveform—if you see stacking, back off the rate.

Paediatric Quick-Set

Kids aren’t small adults—here’s a cheat sheet:

VT: 6–8 mL/kg actual weight
RR by age:
- Neonate: 30–40 bpm
- Infant: 25–30 bpm
- Child: 20–25 bpm
PEEP: 3–5 cmH₂O
FiO₂: Start 100 %, titrate to SpO₂ ≥ 94 %

Heads up: double-check your weight estimate—small errors mean big changes.

Ready for More?

You’ve just seen the core ventilation tricks—imagine having 20 download-and-go Crit Cards in your pocket covering everything from RSI to electrolytes to sepsis bundles.

Unlock the full Crit Cards e-Book on Etsy (always 20 % off at A$ 9.99)
👉 Grab the 20-page pocket e-Book