Respiratory Therapy Formulas and normal values: Guidelines to adjusting Ventilator settings:

1. Ideal Body Weight (IBW): 1. PaCo2 > 45 4. SpO2 >95%

a. Female: 100 lb for 1st 5ft + 5lbs ea additional inch a. increase RR a. reduce Fio2 –60%
b. Male: 106 lb for 1st 5 ft + 6lbs ea additional inch b. increase VT b. reduce PEEP to 5
2. Static Compliance: (VT/Static pressure – PEEP) 2. PaCo2 <35 c. reduce FiO2
a. Normal = 60-100 a. decrease rate
b. <60 = lungs becoming less compliant b. decrease VT
c. >25 is acceptable 3. PCO2 <90% or SaO2<60
d. <25 is unacceptable a. increase FiO2 to 60%
3. Desired FiO2 = Desired PaO2 + Known FiO2 b. increase PEEP
Known PaO2 c. increase FiO2 to 100%
4. Desired Ve= Known Ve*Known PaCO2
Desired PaCO2
5. RAW: PIP–Plateau/ Flow, or PIP–plateau EKG and rhythm strip interpretations:
6. French size sx catheter = ETT size * 3/2 1. Pulmonary Embolism:
8. PAO2: (713 *Fio2 – PaCO2)/0.8or 0.1 if 100% O2 a. S wave in lead I
9. A-a gradient: PAO2 – PaO2 b. ST depression in lead II
a. Normal on RA = 10-40 or on 100% = 25 – 70 c. Large Q wave in lead III
b. Increased 66-300 = acute lung injury d. T wave inversion in lead III
c. >300 = severe shunting, ARDS (unacceptable) 2. Basics:
10. Shunt % = A-a gradient/20; normal=20% a. ST depression = acute blood loss
-- if >20 an increase in PEEP is indicated b. Q Wave makes diagnosis of infarct
11. a-A ratio: PaO2-PAO2 c. Q wave one small square is MI
a. Normal = 80% (74% elderly) d. Inverted T-wave is ischemia
b. 60% = V/Q imbalance 3. Posterior wall Infarct:
c. 15% = shunting a. ST depression in V1 & V2 if acute
12. P/F Ratio: PaO2/FiO2 b. Large R in V1 and V2
a. Normal = 300 – 500 c. Maybe Q in V6
b. Acute lung injury = 200 – 300 d. Inverted mirror test V1 & V2
c. <200 = ARDS 4. Lateral wall Infarct:
13. Expected PaO2 = FiO2 x5 a. Q in leads I and AVL (V5, V6)
a. Used to determine if pt oxygenating better 5. Inferior wall Infarct:
b. Actual PaO2/ Expected PaO2 = % of patient a. Q in leads II, III, & AVF
expected PaO2 b. ST elevated if acute
14. PS should be set to= RAW or > if therapy indicated. 6. Anterior wall Infarct:
15. e-cylinder time remaining=0.30(PSI) / LPM a. ST elevation V1 & V2
16. Oral intubation = 21-25cm @ lip. b. Q in V1, V2, V3 or V4
17. Nasal intubation = 26-29cm c. V1 & V2 = Anterioseptal
17. PEEP therapy = >6-8 CWP d. V3 & V4 = Anteriolateral
18. Humidity should be set at 37 degrees Celcius. 7. SVT: Narrow QRS & rate of 150-250
20. Suction:Adult=100-120,Child=80-100,Infant=60-80 8. LBBB: 2 R waves in V5 & V6
21. Pt.WOB=<0.8=normal, measures effectiveness of 9. RBBB: a. 2 R waves in V1 & V2
rise time and sensitivity. Measured in spont. mode. b. QRS wide and looks like an M
10. Acidosis: Smaller amplitude
11. COPD: Small amplitude, Right axis deviation
Acute Lung Injury or ARDS Ventilator Strategy: 12. 2nd degree block type I: a. PR interval
Lung Protective Ventilation becomes progressively longer until 1 QRS
1. Ideal VT = 6 ml/kg IBW skipped. b. blocked QRS after every 2-5 QRSs
2. Oxygenation target: a. PaO2 55-80 b. SpO2 88-95% c. QRS may be normal or wide if BBB
3. pH Goal: 7.45-7.30 13. 2nd degree type II: a. p waves for ea. QRS at
a. >7.45: Decrease Rate ratio of 2:1, 3:1 or 4:1. b. Often wide w/RBBB
b. <7.30: Increase Rate (maximum rate = 35)
c. If rate >35, or CO2 <25, consider HCO3
d. < 7.15?, increase VT 1ml/kg
(may exceed Static Pressure) Level of Consciousness:
1. Lethargic/ somnolence: sleepy
4. Plateau pressure: Dr. to select target pressure
a. If >30? & due to VT, decrease VT by 50cc Q1 2. Stuporious/confused: responds inappropriately, OD,
intoxication
until p-plat < 30, but do not let VT get <4cc/kg
b. If <25? & VT < ideal VT, increase VT by 3. Semi-comatose: responds only to painful stimuli
4. Comatose: does not respond to painful stimuli
50cc Q1 until ideal VT is reached, so long as
p-plat remains < 30. 5. Obtunded: drowsy, maybe decreased cough/gag reflex
5. Pts usually tachypneic, may be uncomfortable, & may fight
the ventilator. Increased sedation may be indicated.
Respiratorytherapycave.blogspot.com 09/07/2009