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Vent control

Ventilation knobs

Set tidal volume from predicted body weight and adjust respiratory rate to pH/PaCO₂ while avoiding dynamic hyperinflation.

Minute ventilationVT × RR.Obstructive I:EExpiratory time and air trapping.Flow not back to baselineAuto-PEEP pathway.

Core approach

  • Use 4–8 mL/kg predicted body weight; 6–8 mL/kg is a common general scaffold and 4–6 mL/kg is often used for ARDS or high lung-injury risk.
  • Adjust RR and reassess pH/PaCO₂ rather than increasing VT reflexively.

Important exceptions

  • Severe metabolic acidosis may require a substantially higher minute ventilation than routine starting ranges; minimize apnea and reassess a blood gas early.
  • In obstructive disease, raising RR can shorten expiratory time, worsen auto-PEEP, and cause hypotension.

Evidence and use limits

Last reviewed: 2026-07-17. Designed for: emergency medicine learners, clinicians, EMS, RT, and airway educators.

This is an educational cognitive aid, not a bedside order set. Confirm medications, ventilator changes, pediatric dosing, procedures, and escalation decisions against the patient’s physiology, the ventilator in use, and local ED/ICU/anesthesia/pharmacy/RT/EMS/pediatric policy.

Full references · Editorial policy · AARC 2024 ventilator assessment · ATS/ESICM/SCCM lung-protective ventilation · ATS 2024 ARDS update

About this resource
Created by: Andrew Pirotte, MD; Kyle Brown, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: Emergency medicine faculty review completed. Medication content reviewed by Amanda Vanderwerf, PharmD, BCEMP, and Morgan Kimball, PharmD, BCEMP. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: [email protected]