Operation
6-9
Guidelines for using PPV
NOTE: The guidelines below are based on recommendations by
clinicians. They do not replace the clinical judgment of a
physician and should not, on their own, be used for clinical
decision making.
Determining Max R and Max E settings
It is recommended you set Max R (flow assist) and Max E (volume assist) to
initial values and then titrate them based on the patient’s disease process:
• Obstructive disease (COPD, asthma): Focus on Max R. Overcoming
increased resistance is typically the emphasis, not volume delivery.
• Restrictive disease (neuromuscular, chest-wall deformities, obesity
hypoventilation): Focus on Max E. Maintaining sufficient volume is
typically the emphasis, not overcoming increased resistance.
• Mixed disease processes affecting both resistance and elastance:
Titrate both Max R and Max E settings.
Suggested titration procedure Follow this procedure to titrate settings to
optimize patient comfort while avoiding overassisting. See also the flow chart
in Figure 6-3.
NOTE: You may also need to adjust PPV % according to patient response, as
you do for the other PPV settings described below. Mask leakage,
especially a sudden increase, is interpreted as patient effort by the
ventilator and assisted accordingly; this may necessitate lowering the
PPV % setting. However, the best solution is to maintain a minimal
leak.
1. Set EPAP, O
2
, alarm limits, and backup settings to appropriate values.
The HIP alarm limit should be greater than Max P.
Suggested starting settings:
EPAP 4 cmH
2
O
*
* Consider higher EPAP settings for COPD patients to treat autoPEEP as evidenced by
missed triggers
O
2
Current setting or per prescription
Max P 25 cmH
2
O
Max V 1000 to 1500 mL
PPV % 80 to 100%
Max E 5 cmH
2
O/L
Max R 2 cmH
2
O/L/s
All other backup settings
and alarms
Per usual protocol
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