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Typical initial settings for common modes of invasive mechanical ventilation

Setting	Volume-limited		Pressure-limited	Notes
Setting	Volume-limited assist control ventilation	Synchronized intermitted mechanical ventilation with pressure support	Pressure-limited assist control ventilation	Notes
Tidal volume	6 mL/kg PBW	6 mL/kg PBW	Inspiratory pressure is set to target an approximate desired tidal volume (refer below)	Range is 6 to 8 mL/kg non-ARDS patients; 4 to 8 mL/kg ARDS patients.
Ventilator rate	12 to 16 breaths per minute	12 to 16 breaths per minute	12 to 16 breaths per minute	Higher rates may be necessary for patients with ARDS (eg, ≤35 breaths per minute).
PEEP	5 to 10 cm H₂O	5 to 10 cm H₂O	5 to 10 cm H₂O	Lower levels are appropriate if an air leak is present and in patients who do not have ARDS (eg, 3 to 5 cm H₂O); upward adjustment if hypoxemia from ARDS is severe.
FiO₂	FiO₂ to target SpO₂ 90 to 96%*	FiO₂ to target SpO₂ 90 to 96%*	FiO₂ to target SpO₂ 90 to 96%*	A lower limit may also be appropriate (eg, a PaO₂ of 55 mmHg and an SpO₂ of 88% in patients who are difficult to oxygenate or patients with hypercapnic hypoxemic respiratory failure. Higher limits may be necessary in certain conditions.^¶
Inspiratory flow	40 to 60 L per minute; ramp pattern Target an I:E ratio of 1:2 to 1:3^Δ	40 to 60 L per minute; ramp pattern Target an I:E ratio of 1:2 to 1:3	40 to 60 L per minute; ramp pattern Target an I:E ratio of 1:2 to 1:3	Higher rates up to 75 L per minute that increase the I:E ratio are appropriate in patients with airflow obstruction.
Trigger sensitivity	2 L/min (flow-triggered) –1 to –2 cm H₂O (pressure triggered)	2 L/min (flow-triggered) –1 to –2 cm H₂O (pressure triggered)	2 L/min (flow-triggered) –1 to –2 cm H₂O (pressure triggered)	Pressure triggering should not be used when auto-PEEP is suspected.
PSV level	N/A	5 to 10 cm H₂O	N/A	PSV may be adjusted to target a desired tidal volume for unsupported breaths.
Inspiratory pressure	N/A	N/A	Variable (typically between 12 and 25 cm H₂O)	The initial inspiratory pressure varies depending upon lung compliance, airway resistance, and tubing resistance.

PBW: predicted body weight (ie, ideal body weight); ARDS: acute respiratory distress syndrome; PEEP: positive end-expiratory pressure; FiO₂: fraction of inspired oxygen; SpO₂: peripheral oxygen saturation; PaO₂: arterial oxygen tension; I:E ratio: inspiratory:expiratory ratio; N/A: not applicable; PSV: pressure support ventilation.
* Patients are often started on an FiO₂ of 1 immediately after intubation and weaned quickly over 30 minutes to reach the minimum FiO₂ needed to achieve the target SpO₂.
¶ Conditions where higher FiO₂ is indicated include carbon monoxide toxicity, cluster headaches, sickle cell crisis, pneumothorax, pregnancy, and air embolism.
Δ Pressure-regulated volume-controlled ventilation sets an inspiratory time rather than setting the inspiratory flow to target the same I:E ratio.

Graphic 123028 Version 3.0