Caring for the ventilated patient: modes and settings in general terms, the hourly check and what to record
- Safe practice
The nurse checks the patient first, then the ventilator: settings, pressures, alarms, tube and circuit, and records the trend.
What it is
A mechanical ventilator pushes gas into the lungs with positive pressure through an endotracheal tube or a tracheostomy. The medical team and the respiratory therapist choose the mode and settings. The nurse confirms they match the order, watches how the patient responds and acts on alarms. In general terms: in volume control the ventilator gives a set tidal volume at a set rate and the pressure varies with the lungs; in pressure control it gives a set pressure for a set time and the volume varies with lung stiffness and airway resistance; in pressure support the patient triggers every breath and the ventilator helps it, so a patient effort is needed and an apnoea alarm protects the patient. PEEP keeps lung units open at the end of expiration, and FiO2 is the fraction of oxygen given.
What it requires
- A written order with the mode and settings, and a team that includes the respiratory therapist where available.
- Continuous monitoring of SpO2 and ECG, with capnography when available.
- Alarms switched on and set to the protocol limits.
- A bag-valve device with oxygen, suction and the equipment to manage the airway at the bedside.
- Arterial blood gases as ordered, to judge whether the settings work.
Components
- Mode (volume control, pressure control, pressure support or another the team chooses).
- Tidal volume or inspiratory pressure, and respiratory rate.
- PEEP and FiO2.
- Trigger sensitivity and inspiratory time or I:E ratio.
- Alarms: high pressure, low pressure or low volume, minute ventilation, rate and apnoea.
How it is applied (and why)
- Assess the patient first: consciousness, comfort, colour, chest rise, breath sounds, SpO2 and effort — the patient is the priority.
- Compare the mode and settings on the screen with the order — a wrong setting is a silent error.
- Read peak and plateau pressure, delivered volume, rate and minute ventilation, and compare with the last check — trends warn early.
- Confirm the alarms are on and set to the protocol limits — wide limits miss problems.
- Check tube depth, cuff, fixation and the circuit for kinks, water or disconnection — most sudden problems start there.
- Check the humidifier water or the heat-moisture exchanger and filters, and replace them if soiled — they protect airway and staff.
- Keep the head raised 30–45°, give oral care and turn the patient every 2 h as the protocol says — it prevents VAP and pressure injuries.
- Assess pain, sedation and delirium with the unit's scales and support light sedation — less sedation shortens ventilation.
- Send blood gases as ordered, often about 1 h after a change — PaCO2, PaO2 and pH show whether the settings work.
- Record settings, measured values, alarms, tolerance and actions — the next shift sees the trend.
Modes in general terms (the team sets the values)
| Mode | What is set | What varies | What the nurse watches |
|---|---|---|---|
| Volume control | Tidal volume and rate | Airway pressure | Rising peak or plateau pressure |
| Pressure control | Inspiratory pressure, time and rate | Tidal volume | Falling delivered volume and minute ventilation |
| Pressure support | Support pressure and PEEP; the patient triggers | Volume, rate and timing | Apnoea, fast shallow breathing, fatigue |
In nursing practice
- Positive pressure lowers venous return: watch blood pressure after intubation and after PEEP or volume changes.
- A patient fighting the ventilator may have pain, anxiety, secretions, a tube problem or a setting that does not fit: assess before sedating more.
- A plateau pressure above 30 cmH2O, or one that keeps rising, is reported: lung-protective targets aim below it.
- Daily awakening and breathing trials and early mobilisation shorten ventilation (see the weaning page).
Common mistakes
- Looking at the screen and not at the patient.
- Disconnecting the circuit when it is not needed: PEEP is lost and lung units collapse.
- Recording an estimated height: predicted body weight, and so the tidal volume target, will be wrong.
- Changing the ventilator circuit on a schedule instead of only when it is soiled or damaged.
- Leaving the bedside without a bag-valve device and oxygen ready.
Test yourself
Think of the answer, then tap the question to see it.
In volume control ventilation, what does the ventilator keep fixed and what varies?
It keeps the tidal volume and rate fixed; the airway pressure varies with lung stiffness and airway resistance.
Why does pressure support need an apnoea alarm?
Because every breath must be started by the patient. If the patient stops breathing, the alarm and the backup settings protect them.
How often does the WHO toolkit suggest checking peak and plateau pressure, rate and alarms?
Every 2–4 hours and about 1 hour after any ventilator change.
Why must the patient's height be measured accurately?
Predicted body weight comes from sex and height, and the lung-protective tidal volume is calculated from it, not from the actual weight.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Clinical care for severe acute respiratory infection: toolkit, update 2022 (COVID-19 adaptation), tools 4.7, 9.9 and 9.14 (World Health Organization, 2022); Clinical management of COVID-19: living guideline, 18 August 2023 (World Health Organization, 2023); Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 update (Infection Control & Hospital Epidemiology, SHEA/IDSA/APIC (open access, PMC), 2022); The hemodynamics of tracheal intubation in critically ill patients: a narrative review (Journal of Intensive Care (open access, PMC), 2026).
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Representative model, for educational purposes only.