For patients with active bronchoconstriction (e.g. COPD, asthma)
The best ventilatory strategy for these patients is to avoid intubation if possible; mechanical ventilation will often make the pulmonary situation worse, rather than better.
Goal = adequate time for expiration
Frequently requires deep sedation and analgesia (first-line); may required paralysis (second-line)
Volume-assist control
Vt = 6-8 cc/kg of Ideal Body Weight
Ideal Body Weight used because lung parenchyma does not increase in size as the person gains more weight
Ideal Body Weight used because lung parenchyma does not increase in size as the person gains more weight
60-80 L/minute
Some advocate for higher rates (e.g. 80-100 LPM) to allow more expiration time, however this will increase the peak pressures and has not shown to produce any clinically meaningful change in the expiration time
Some advocate for higher rates (e.g. 80-100 LPM) to allow more expiration time, however this will increase the peak pressures and has not shown to produce any clinically meaningful change in the expiration time
Titrate FiO2 to desired SpO2
Set PEEP 0-5
Set low - 10 BPM
Adjust for I:E 1:4 or 1:5
Permissive hypercapnia to avoid breath stacking
Ok as long as pH > 7.00-7.10
Maintain plateau pressure <30
If >30 go down on rate
Ok as long as pH > 7.00-7.10
Maintain plateau pressure <30
If >30 go down on rate
If >30 go down on rate
Initial mechanical ventilation settings 
Ventilation modes
Chest x-ray interpretation
Mechanical ventilation 
Delayed sequence intubation
Noninvasive ventilation
Airway pressure release ventilation
Neonatal resuscitation