title: Ventilator settings and monitoring parameter targets for initiation of continuous mandatory ventilation: a questionnaire study.
abstract: OBJECTIVE
  To inform development of educational tools, we sought to identify initial ventilator settings and monitoring targets for 3 scenarios.
  
  
  METHODS
  A survey was e-mailed to Canadian Society of Respiratory Therapists members with 2 reminders in March/April 2011.
  
  
  RESULTS
  Total evaluable surveys were 363. More participants selected pressure as opposed to volume ventilation for acute respiratory distress syndrome (ARDS; 77%) than for chronic obstructive pulmonary disease (COPD; 50%) and postoperative ventilation (32%; P < .001). Mean tidal volume was lower for ARDS than for COPD and postoperative ventilation (5.7, 6.9, and 7.2 mL/kg, respectively; P < .001). Maximum acceptable plateau pressures were highest for ARDS (30 cm H2O vs 29 cm H2O [COPD] and 27 cm H2O [postoperative], P < .001). Initial positive expiratory end pressure (12 cm H2O vs 7 cm H2O vs 5 cm H2O) and fraction of inspired oxygen (Fio2; 1.0 vs 0.5 vs 0.3) were also higher for ARDS (both P < .001); however, only 8% selected a positive expiratory end pressure/Fio2 combination as recommended by ARDSnet. Values of oxygen saturation as measured by pulse oximetry of 97% (ARDS) and 94% (COPD and postoperative) were considered appropriate for Fio2 reduction. The lowest pH was 7.28 vs 7.23 vs 7.26; the highest pH was 7.46 vs 7.44 vs 7.46 (P < .001). Partial pressure of carbon dioxide (arterial) of 51 mm Hg (postoperative) to 65 mm Hg (ARDS) was considered acceptable.
  
  
  CONCLUSIONS
  Lung protective ventilation was favored, yet distinct differences in ventilator settings were evident. Monitoring targets suggested relatively conservative practices for Fio2 reduction but an understanding of permissive hypercapnia.
authors: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, Toronto, Ontario, Canada; Mount Sinai Hospital and the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada. Electronic address: louise.rose@utoronto.ca.
authors: Louise
authors: L
authors: Rose
authors: Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
authors: Lisa
authors: L
authors: Kenny
authors: Department of Anesthesia and Pain Management at the Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Gordon
authors: G
authors: Tait
authors: Department of Critical Care, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors: Sangeeta
authors: S
authors: Mehta
mesh_terms: D002170:Canada; D002245:Carbon Dioxide / Q000097:blood; D003430:Cross-Sectional Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration; D011182:Postoperative Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012138:Respiratory Therapy; D011795:Surveys and Questionnaires; D013990:Tidal Volume
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
keywords: ARDS; COPD; Education; Mechanical ventilation; Survey