We had a spinal cord injury patient, a QUAD, arrive at our facility the other day on these ventilator settings: TV 1700cc A/C rate 10 FIO2 21% and 92inches of deadspace added to the ventilator circuit.I don't understand the reason for such a large TV.They said the need for 92in of deadspace was to off set the washing out of the pCO2 due to the large Tidal volumes,and that the large tidal volumes, was to prevent atelectasis.Why wouldn't a lower tidal volume and peep work for this patient?

This is really unfortunate.

Hi,

It used to be the policy at spinal cord centers to use very large tidal volumes and add deadspace because the ventilators in-use did not offer leak compensated PEEP and most people in this situation have leaks around their trachs.

Centers that are using newer devices that offer leak compensated PEEP are using PEEP instead but for many patients, this transition is difficult because they have become accustomed to the large tidal volumes.

Volume does not recruit, pressure does, otherwise there would never be patients coming out of O.R. with actelectsis.

I believe one of if not the orignal high Vt with Dead space users was Dr. Pete Peterson from Craig specialty hospital in Englewood, Colorado. I have used this way of ventilation on Quads at Swedish Medical Center which is attached to Craig. Though I don't know current Quad ventilation protocol at Craig/Swedish, I found this to be very effective with Quads in and around 1999-2000.

Thanks for the insight GJ,RRT.

Was thinking about the high Vt vs. PEEP for recruitment in the quad patient population. How much PEEP would it take to keep a quad recruited? I imagine it would be pretty uncomfortable to live with peep of 10-20 all the time on an LTV 950. High PEEP wouldn't work with the patient's cuff down. High Vt with +0PEEP appears to be beneficial for some patients.