Ventilator Settings

Updated: 
April 1, 2024
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Ventilator Settings

  1. Tidal Volume (VT):
    • Amount of air delivered with each breath.
    • Usually set between 6 to 8 milliliters per kilogram of ideal body weight.
  2. Respiratory Rate (RR):
    • Number of breaths delivered per minute by the ventilator.
    • Typically set based on the patient's condition and blood gas analysis.
  3. Fraction of Inspired Oxygen (FiO2):
    • Percentage of oxygen delivered by the ventilator.
    • Adjusted to maintain adequate oxygenation, usually starting at 100% and weaning down as tolerated.
  4. Positive End-Expiratory Pressure (PEEP):
    • Pressure applied to the airways at the end of exhalation to prevent alveolar collapse.
    • Helps maintain lung recruitment and improve oxygenation.
    • Commonly set between 5 to 10 cmH2O.
  5. Peak Inspiratory Pressure (PIP):
    • Maximum pressure applied during inhalation.
    • Should be monitored to prevent lung injury.
  6. Flow Rate:
    • Rate at which gas is delivered to the patient during inspiration.
    • Higher flow rates may improve ventilation but can increase the risk of barotrauma.
  7. Trigger Sensitivity:
    • Determines how sensitive the ventilator is to the patient's efforts to breathe.
    • Adjusted to avoid patient-ventilator asynchrony.
  8. Mode of Ventilation:
    • Determines how the ventilator delivers breaths to the patient.
    • Common modes include:
      • Assist-Control (AC) Mode:
        • In AC mode, the ventilator delivers a set number of breaths per minute (respiratory rate) to the patient.
        • Each breath can be either triggered by the patient's effort (triggered breath) or delivered by the ventilator at the set rate (mandatory breath).
        • If the patient initiates a breath, the ventilator delivers a full tidal volume according to the set parameters.
        • AC mode is commonly used in patients who are unable to breathe adequately on their own or require full ventilatory support.
      • Synchronized Intermittent Mandatory Ventilation (SIMV) Mode:
        • In SIMV mode, the ventilator delivers a set number of mandatory breaths per minute, similar to AC mode.
        • However, patients can also initiate spontaneous breaths between the mandatory breaths.
        • Spontaneous breaths are not fully supported by the ventilator and may be augmented by pressure support or flow triggering.
        • SIMV is often used in patients who have some respiratory drive but may require assistance to maintain adequate ventilation.
      • Pressure Support (PS) Mode:
        • In PS mode, the ventilator delivers a preset level of positive pressure to support each spontaneous breath initiated by the patient.
        • The pressure support augments the patient's effort to overcome resistance and achieve adequate tidal volume.
        • PS mode is commonly used to support patients who are breathing spontaneously but require assistance to reduce the work of breathing.
      • Continuous Positive Airway Pressure (CPAP) Mode:
        • In CPAP mode, the ventilator delivers a constant positive pressure throughout the respiratory cycle.
        • CPAP is primarily used to maintain airway patency and improve oxygenation in spontaneously breathing patients.
        • It is often used in patients with sleep apnea or acute respiratory failure who can maintain their own ventilation but require support to prevent airway collapse.
      • Volume-Controlled Ventilation (VCV) Mode:
        • In VCV mode, the ventilator delivers a preset tidal volume with each breath, regardless of changes in the patient's lung compliance or airway resistance.
        • The ventilator adjusts the inspiratory flow rate to achieve the desired tidal volume.
        • VCV is commonly used in patients with acute respiratory failure to ensure consistent delivery of tidal volume.
      • Pressure-Controlled Ventilation (PCV) Mode:
        • In PCV mode, the ventilator delivers breaths at a preset pressure level, allowing for variable tidal volumes based on changes in lung compliance and airway resistance.
        • The inspiratory time is fixed, and the tidal volume achieved depends on the patient's lung mechanics.
        • PCV is often used in patients with acute respiratory distress syndrome (ARDS) or conditions requiring lung-protective ventilation strategies.

Anesthesia

  • ​Cumulative Anesthetic (Off Service Anesthesia+ OMFS) Experience:
  • general anesthesia/deep sedation for a minimum of 300 cases.
  • Must involve care for 50 patients younger than 13.
  • A minimum of 150 of the 300 cases must be ambulatory anesthetics for oral and maxillofacial surgery outside of the operating room.

Major Surgery

  • Final Year Requirement:
  • 175 major oral and maxillofacial surgery procedures on adults and children, documented by at least a formal operative note.
  • For the above 175 procedures there must be at least 20 procedures in each category of surgery. Sufficient variety in each category, as specified below, must be provided.
  • The categories of major surgery are defined as: Trauma, Pathology, Orthognathic Surgery, Reconstructive and Cosmetic Surgery
  • Surgery performed by oral and maxillofacial surgery residents while rotating on or assisting with other services must not be counted toward this requirement
  • ​​Surgical procedures performed during foreign rotations must not count toward fulfillment of the 175 major surgical procedures.

Research

  • Oral or poster presentations at scientific meetings aside from program curriculum
  • Submission for publication of abstracts, journal articles (particularly peer reviewed) or book chapters
  • Active participation in or completion of a research project (basic science or clinical) with mentoring

Certifications

  • ACLS maintained throughout residency
  • PALS- certified during residency
  • ATLS- certified during residency

Accepted Codes by Category:

Select Surgical Category

Cleft

Alveolar

  • 42205, 42210

Lip

  • 40700, 40701, 40702, 40720, 40761, 42260

Palate

  • ​42200, 42215, 42220, 42225, 42226, 42227, 42235, 42950

Craniofacial

Osteotomies

  • 21137, 21138, 21139, 21150, 21151, 21154, 21155, 21159, 21160, 21172, 21175, 21179, 21180, 21181, 21182, 21183, 21184, 21260, 21261, 21263, 21267, 21268, 21275, 61557, 61559

Esthetic

Augmentation/Reduction Surgery

  • 21120, 21125, 21127, 21208, 21209, 21270

Chemodenervation

  • 64612

Fillers

  • 11950, 11951, 11952, 11954

Soft Tissue Facial Non-Surgical

  • 15780, 15781, 15782, 15783, 15786, 15787, 15788, 15789, 15792, 15793, 17004, 17106, 17107, 17108

Soft Tissue Facial Surgical

  • 15819, 15820, 15821, 15822, 15823, 15824, 15825, 15826, 15828, 15829, 15876, 67900, 67901, 69300

Rhinoplasty

  • ​15760, 21235, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30520

Infection

Major

  • 10061, 10121, 10140, 10180, 40801, 41005, 41006, 41007, 41008, 41009, 41015, 41016, 41017, 41018, 42300, 42305, 42310, 42320, 42700, 42720, 42725

Minor

  • 10060, 10120, 10160, 21501, 40800, 41000, 41800, 41805, 41806

Orthognathic

Genioplasty Osteotomies

  • 21121, 21122, 21123

Mandibular Osteotomies

  • 21193, 21194, 21195, 21196, 21198, 21199

Maxillary Osteotomies

  • ​21141, 21142, 21143, 21145, 21146, 21147, 21188, 21206

Pathology

Biopsies

  • 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 20240, 20245, 21550, 40490, 40808, 41100, 41105, 41108, 42100,42400, 42405

Lesion Excision/Resection Bone Benign

  • 20615, 21025, 21026, 21029, 21030, 21040, 21046, 21047, 21048, 21049, 21295, 21296, 41825, 41826, 41827, 41850

Lesion Excision/ Resection Malignant

  • 11620, 11621, 11622, 11623, 11624, 11626, 11640, 11641, 11642, 11643, 11644, 11646, 17270, 17272, 17273, 17274, 17276, 17280, 17281, 17282, 17283, 17284, 17286, 21015, 21034, 21044, 21045, 21557, 40500, 40510, 40520, 40530, 41120, 41130, 41135, 41140, 41145, 41150, 41153, 41155

Lesion Excision/Resection Soft Tissue Extraoral/Benign

  • 11420, 11421, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 17000, 17110, 21555, 42810, 42815

Lesion Excision/Resection Soft Tissue Intraoral/Benign

  • 40810, 40812, 40814, 40816, 40820, 41110, 41112, 41113, 41114, 41116, 42104, 42106, 42107, 42120

Salivary Gland

  • 42330, 42335, 42408, 42409, 42410, 42415, 42420, 42425, 42426, 42440, 42450

Sinus

  • 30580, 31030, 31032

Preprosthetic

Implants

  • 21244, 21245, 21246, 21248, 21249, D6010

Preprosthetic Surgery

  • 40840, 40842, 40843, 40844, 40845, 41822, 41823, D4263

Preprosthetic Surgery Soft Tissue

  • 40818, D4273, D4275, D4276, D4277, D4278

Reconstruction

Cartilage Grafting

  • 20912, 21230

Major Bone Grafting Free Bone Grafting

  • 20969, 20970, 20972, 21210, 21215

Microvascular

  • 15757, 20955, 20956, 20957, 20962

Nerve Surgery

  • 64716, 64732, 64734, 64736, 64738, 64742, 64885, 64886

Salivary Duct

  • 42500, 42505, 42507, 42509, 42510, 42665

Soft Tissue Flap Local/Adjacent

  • 14020, 14021, 14040, 14041, 14060, 14061

Soft Tissue Flap Regional/Nearby

  • 15572, 15574, 15576, 15610, 15620, 15630, 15732, 40525, 40527

Soft Tissue Graft Free Skin Grafting

  • 15120, 15121, 15220, 15221, 15240, 15241, 15260, 15261, 15770

Temporomandibular Joint

Arthroscopy

  • 29800, 29804

Minimally Invasive

  • 20605, 21480, 21485

Open Joint

  • 21010, 21050, 21060, 21070, 21240, 21242, 21490

Reconstructive Autogenous

  • 20910

Reconstructive Prothetic

  • 21243

Tracheostomy

Tracheostomy

  • 31600, 31601, 31603, 31605, 31610

Trauma

Dentoalveolar Trauma

  • 21440, 21445, D7270

Mandible Fractures

  • 21450, 21451, 21452, 21453, 21454, 21461, 21462, 21465, 21470

Midface/Upper Face Fractures, Frontal Sinus Fractures

  • 21343, 21344

Midface/Upper Face Fractures, LeFort Fractures

  • 21345, 21346, 21347, 21348, 21421, 21422, 21423, 21431, 21432, 21433, 21435, 21436

Midface/Upper Face Fractures, Malar Fractures

  • 21356, 21360, 21365, 21366

Midface/Upper Face Fractures, Nasal Fractures

  • 21310, 21315, 21320, 21325, 21330, 21335, 21336, 21337, 30020

Midface/Upper Face Fractures, NOE Fractures

  • 21338, 21339, 21340

Midface/Upper Face Fractures, Orbital Fractures

  • 21280, 21282, 21385, 21386, 21387, 21390, 21395, 21400, 21401, 21406, 21407, 21408

Repair of Lacerations Extraoral

  • ​12001, 12002, 12004, 12005, 12006, 12007, 12011, 12013, 12014, 12015, 12016, 12017, 12018, 12031, 12032, 12034,12035, 12036, 12037, 12041, 12042, 12044, 12045, 12046, 12047, 12051, 12052, 12053, 12054, 12055, 12056, 12057, 13120, 13121, 13122, 13131, 13132, 13133, 13151, 13152, 13153, 40650, 40652, 40654, 40830, 40831

Repair of Lacerations Intraoral

  • 41250, 41251, 41252, 42180
Select Drug Category

Lidocaine (Xylocaine):   - Maximum Dose without Epinephrine: 4.5 mg/kg (without epinephrine)   - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine)   - Toxicity: Symptoms of lidocaine toxicity may include dizziness, confusion, seizures, cardiovascular collapse, and cardiac arrest.

Bupivacaine (Marcaine):   - Maximum Dose without Epinephrine: 2 mg/kg (without epinephrine)   - Maximum Dose with Epinephrine: 3 mg/kg (with epinephrine)   - Toxicity: Bupivacaine toxicity can cause significant cardiotoxicity, leading to cardiac arrhythmias, cardiac arrest, and central nervous system (CNS) effects such as seizures and dizziness.

Mepivacaine (Carbocaine):   - Maximum Dose without Epinephrine: 4.5 mg/kg (without epinephrine)   - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine)   - Toxicity: Symptoms of mepivacaine toxicity are similar to other local anesthetics and may involve CNS and cardiovascular effects.

Procaine (Novocaine):   - Maximum Dose without Epinephrine: 7 mg/kg (without epinephrine)   - Maximum Dose with Epinephrine: Not typically used with epinephrine   - Toxicity: Procaine toxicity may present with symptoms similar to other local anesthetics but is less frequently used today due to its shorter duration and higher allergenic potential.

Articaine (Septocaine):   - Maximum Dose without Epinephrine: 7 mg/kg (without epinephrine)   - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine)   - Toxicity: Articaine has a longer duration of action but can cause similar toxicity symptoms as other local anesthetics if administered excessively or if there's accidental intravascular injection.

Select an Electrolyte

Hypokalemia (Low Potassium Levels):  

- Mild to Moderate Hypokalemia (3.0-3.5 mEq/L):    

- Oral potassium supplementation: Potassium chloride tablets or liquid, 20-40 mEq orally per day in divided doses.  

- Severe Hypokalemia (<3.0 mEq/L):    

- IV potassium chloride: Start with 10-20 mEq/hour, under continuous cardiac monitoring.

Hyperkalemia (High Potassium Levels):  

- Mild Hyperkalemia (5.1-6.0 mEq/L):    

- Dietary potassium restriction and discontinuation of potassium supplements.  

- Severe Hyperkalemia (>6.0 mEq/L or with ECG changes):    

- Calcium gluconate or calcium chloride IV to stabilize cardiac membranes.    

- Insulin with glucose IV, beta-agonists (e.g., albuterol), or sodium bicarbonate to shift potassium into cells.     - Loop diuretics or exchange resins (e.g., sodium polystyrene sulfonate) to enhance potassium removal.

Hypocalcemia (Low Calcium Levels):  

- Mild Hypocalcemia (8.0-8.5 mg/dL):    

- Oral calcium supplements: Calcium carbonate or calcium citrate, doses vary based on elemental calcium content.  

- Severe Hypocalcemia (<8.0 mg/dL or symptomatic):    

- IV calcium gluconate or calcium chloride, dosages depend on severity and symptoms.

Hypercalcemia (High Calcium Levels):  

- Mild Hypercalcemia (10.5-11.9 mg/dL):    

- Hydration with IV saline and loop diuretics.  

- Severe Hypercalcemia (>12 mg/dL or symptomatic):    

- Bisphosphonates, calcitonin, or corticosteroids may be used for severe cases.

Hypomagnesemia (Low Magnesium Levels):  

- Mild to Moderate Hypomagnesemia (1.2-1.8 mg/dL):    

- Oral magnesium supplements: Magnesium oxide, magnesium citrate, or magnesium glycinate, dosages vary.  

- Severe Hypomagnesemia (<1.2 mg/dL or symptomatic):    

- IV magnesium sulfate, doses vary based on severity and response.

Hypermagnesemia (High Magnesium Levels):  

- Mild to Moderate Hypermagnesemia (2.5-3.0 mg/dL):    

- Discontinuation of magnesium-containing medications.  

- Severe Hypermagnesemia (>3.0 mg/dL or with symptoms):    

- IV calcium gluconate for severe symptoms.    

- Dialysis may be necessary in extreme cases.

Select Surgical Category
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