INTRODUCTION

Automatic ventilators may be used any time a patient's ventilatory effort would be augmented or provided by Bag Valve Mask device (BVM). This is irrespective of whether or not the patient is intubated. The Tidal Volume should be preset to 10cc/kg of body weight.

1. Determine indications for ventilator use are present and contraindications are not.

2. Support patient's airway and ventilatory support until Ventilator can be applied. (Ventilator application should be very quick, therefore, do not delay if BVM is not already available, attached to O2 and being used).

3. Turn on O2 cylinder at main valve.

4. Attach green, high-pressure line to quick-disconnect. This will initiate ventilator.

5. Set ventilator rate and tidal volume. The ventilator is designed to have a IE ratio (Inspiratory/Expiratory) of 1:2. Hence, the rate and tidal volume delivered are inversely proportional but directly related. Setting should be determined by tidal volume before rate.
   1. Estimate tidal volume by body weight in kgs X 10cc = Tidal Volume.
   2. If patient is already on a ventilator at a facility, request TV setting from patient's chart or Respiratory Therapist.

   3. Quickly attach the black 'patient head' at the end of the white low-pressure line, to either a mask or preferably, the endotracheal tube if already established.

   4. Use of a disposable ventilator circuit extension with one-way valve and filter is preferable, however not required for the ventilator to function properly. Circuit extension should be placed between the black 'patient head' and either the mask or endotracheal tube. (Attachement of the CombiTube is also allowed).

   5. Once the ventilator is applied to the patient, ventilating at the pre-set rate/volume, quickly reassess lung sounds and patient-rise for adequacy of function. Be prepared to adjust setting accordingly. Typical adjustments will be up to 15cc/kg tidal volume. Use your Pulse Oximeter/Capnography meter to assist you with adjustment.

   6. Attach and monitor Pulse Oximeter, recording reading q 3-5 minutes.

   7. Attach Capnography maintain CO2 reading between 35-45.
   8. Verify BVM of appropriate size is set-up, and ready for use in case of ventilator failure.

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   SPECIAL CONSIDERATIONS/NOTES/PRECAUTIONS:
   1. Troubleshooting: Pop-off valve at patient head is being activated, assess for the following in this order;
      1. Tidal volume setting is too high for patient's size. Solution: Adjust setting.
      2. Patient has some respiratory effort and is "fighting" the vent. Solution: Calm the patient, contact Medical Control for sedation if necesarry.
      3. Airway is obstructed. Solution: Verify no foreign objects are obstructing airway. Verify that endotracheal tube, if present, is not kinked or clogged.
      4. The patient's chest wall compliance is too "tight". Possibly secondary to extended downtime, respiratory disease, trauma, pneumothorax/hemothorax, or hypothermia. Solution: BVM support to overcome high pressures until chest wall compliance improves in cases of extended down-time., hypothermia or trauma. Pleural decompression if tension pneumothorax is suspected. If downtime extensive consider termination of efforts, refer to CESSATION OF RESUSCITATION protocol first.

   2. Ventilator is not functioning at all, assess for the following in this order:
      1. O2 supply is empty. Solution: Change O2 supply source.
      2. O2 supply is turned off at a valve between the ventilator and tank. Solution: Open all valves between ventilator and tank.
      3. Green high-pressure line is not attached to quick-disconnect properly. Solution: Disconnect and re-connect the green high-pressure line.
      4. Ventilator has malfunction, which cannot be diagnosed/corrected in the field. Solution: Disconnect and discontinue use of ventilator. Ventilate patient with BVM. Notify Biomedical Services ASAP, and remove from service.

   3. Ventilator is operating at the wrong rate/tidal volume, assess for the following in this order:
      1. Rate/TV setting is incorrect. Solution: Adjust setting manually and reassess.
      2. Ventilator has malfunction, which cannot be diagnosed/corrected in the field. Solution: Disconnect and discontinue use of ventilator. Ventilate patient with BVM. Notify Biomedical services ASAP, and remove from service.

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