Resident lecture – what to set mandatory RR at.

REMEMBER : Always discuss all aspects of respiratory care with the respiratory therapist, the resident, the nurse and the attending physician.

Keeping it simple, there are only 3 general categories to set for mandatory RR.

RR= 16          as a transient solution to increased intracranial pressure (hyperventilation should cause cerebral vasoconstriction and thru the “mass effect”, allow a relative decrease in intracranial pressure to allow for the space occupying lesion that is the head injury.

RR= 6           for any patient deemed “difficult to ventilate” to include status asthmaticus and ARDS.  Lungs should be envision not as two organ systems but rather as individual alveoli.  Then, envision those alveoli inflating and deflating at 24 to 34 time per minute.  It is only a matter of time before a micro-tear appears and now the bioinflammatory cascade is evoked.  It will then be only a matter of time before early ARDS signs & symptoms appear.  Permissive hypercapnea should be entertained.  An acidic cellular milieu should be considered.  Acidemia in itself is a protective environment.  A slow RRmandatory will minimize mechanical trauma.

RR= 10         everyone else not mentioned above.