My name is Patrik Hutzel from intensivecarehotline.com, where we instantly improve the lives for families of critically ill patients in intensive care so that you can make informed decisions, have peace of mind, control, power, and influence, making sure your loved one always gets best care and treatment in intensive care, even if you’re not a doctor or a nurse in intensive care.

So, today’s question comes from one of our clients who says,

“Hi Patrik,

Do you think my dad can breathe on his own if he comes off these settings: CPAP/Pressure Support Mode, PEEP 7, Pressure Support of 15, fiO2 45%?

Why did they put him on this without an ABG? ABG is an arterial blood gas.

His weight is 96 kg. Right, should it be multiplied by 7 for tidal volume? Why do you think they are doing these settings? What can you picture is normal for these settings? Should my dad transfer to another hospital?”

If you’re asking yourself similar questions about your loved one’s ventilator setting or similar ventilator settings, this video is for you.

Let’s break this down step by step so you can really understand what’s going on with your dad on the ventilator. Your dad is currently on CPAP Pressure Support Mode; that’s Continuous Positive Airway Pressure with Pressure Support. This is a weaning mode, meaning the ventilator gives partial support, but your dad has to do most of the breathing effort themselves. It’s usually the last step before someone can be taken off the ventilator, assuming PEEP is low, 5 or less, and pressure support is low, usually 8 or less.

So, let’s look at each setting in detail. PEEP of 7, that’s the pressure left in the lungs at the end of exhalation or expiration, and it helps to keep the alveoli open. A PEEP of 7 is moderate and often used when weaning.

Pressure support of 15, that means the ventilator adds 15 centimeters of pressure during each breath to reduce the patient’s work of breathing. A pressure support of 15 is still quite high, which tells me your dad is not yet ready to breathe entirely on his own.

FiO2 45%, that’s the oxygen concentration being delivered. The goal in weaning is to reduce this below 40%, ideally closer to 30% while maintaining oxygen saturation above 92. Pressure support like I said, should come down ideally below 8 and then tidal volumes also need to stay at least 7mL/kilo per breath.

Arterial blood gases need to be normal. Carbon dioxide and oxygen levels need to be within the normal limit and your dad needs to feel comfortable. He can’t be exhausted. He can’t be breathing fast. He needs to have a normal breathing pattern. He needs to be awake, alert, be able to obey commands pain free, ideally can mobilize. Those ideal scenarios and what you should be aiming for.

So, can your dad breathe on his own right now?

The short answer is not yet safely. He’s still needing moderate ventilator support to trial breathing on his own. We usually want to see pressure support around 5 to 8, PEEP around 5, and fiO2 below 40% and an arterial blood gas confirming that his CO2, O2 (oxygen) and pH are in the safe range.

You’re absolutely right to question why they didn’t do an ABG or an arterial blood gas. An arterial blood gas gives you critical data. It tells the ICU team how well your dad is ventilating and oxygenating. Without that information, it’s like flying blind, really. You can’t safely assess readiness to wean or come off the ventilator without an ABG, you’d only be guessing. So, if that hasn’t been done recently, insist on it. It’s your right to know the results. It’s your dad’s right to know the results.

So, you mentioned your dad weighs 96 kg. Ventilator settings like tidal volume are usually based on ideal body weight, not actual weight. Normal target is 6 to 8mL/kg per predicted body weight, but some literature also suggests 7 to 10 mL/kg. That’s roughly around 670 mL per breath, but it depends heavily on his height and lung condition as well. If he’s got ARDS (Acute Respiratory Distress Syndrome), pneumonia, fluid overload, COPD (Chronic Obstructive Pulmonary Disease), asthma, smaller tidal volumes are safer to protect the lungs.

So why those settings? So why are they using these particular settings? They suggest to you that it has some lung stiffness or reduced lung compliance, respiratory muscle weakness or residual infection or inflammation, or potentially fluid overload. He’s probably not quite ready yet for a full breathing trial, but he’s being supported to gradually regain strength.

Should he transfer to another ICU?

Now the big question is, should your dad transfer to another ICU? That depends on a few key things. Is he clinically stable for a transfer? With what you’ve shared with me, I’d say yes, he is that. Are you losing trust in the ICU team or their communication or both? Is the current hospital not proactive in weaning or giving you updates?

Also, make sure you have access to the medical records, whether you want to transfer your dad or not, you need access to the medical records. If you feel like your dad’s progress has stalled or you’re not being heard, a transfer to a hospital with strong respiratory or weaning expertise can make all the difference. At the end of the day, families have every right to seek a second opinion, which we can give you here at intensivearehotline.com and push for the best care.

In summary, your dad on CPAP pressure support 15, PEEP of 7, FiO2 45%, your dad is still getting moderate ventilator support. He’s not quite ready to breathe entirely on his own yet. An ABG should be done before making any further weaning decisions, and if you feel something’s not right, you’re probably correct.

Get access to the medical records. Contact us here so that myself can talk to doctors and nurses there directly, ask all the right questions. You will see I will ask some questions that you haven’t even considered asking but must be asked. So, get in-depth guidance, get access to the medical records so that we can help you how to safely wean your loved one off the ventilator, and if you’re considering an ICU transfer to another hospital, go to intensivecarehotline.com so we can help you with that.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy because of our insights. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because our advice is absolutely life changing.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care.

That’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always. That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

That’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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