Ventilator Settings

Common Adult Ventilator Settings

1. Tidal Volume (VT):

Amount of air delivered with each breath.
Usually set between 6 to 8 milliliters per kilogram of ideal body weight.

2. Respiratory Rate (RR):

Number of breaths delivered per minute by the ventilator.
Typically set based on the patient's condition and blood gas analysis.
Commonly set between 12 to 20 breaths per minute.

3. Fraction of Inspired Oxygen (FiO2):

Percentage of oxygen delivered by the ventilator.
Adjusted to maintain adequate oxygenation, usually starting at 100% and weaning down as tolerated.
Aim to keep SpO2 (oxygen saturation) >90% or PaO2 (partial pressure of oxygen) between 60-100 mmHg.

4. Positive End-Expiratory Pressure (PEEP):

Pressure applied to the airways at the end of exhalation to prevent alveolar collapse.
Helps maintain lung recruitment and improve oxygenation.
Commonly set between 5 to 10 cmH2O.

5. Peak Inspiratory Pressure (PIP):

Maximum pressure applied during inhalation.
Should be monitored to prevent lung injury.
Generally, keep PIP below 30 cmH2O to minimize risk of barotrauma.

6. Flow Rate:

Rate at which gas is delivered to the patient during inspiration.
Typical initial settings are 40-60 liters per minute.
Higher flow rates may improve ventilation but can increase the risk of barotrauma.

7. Trigger Sensitivity:

Determines how sensitive the ventilator is to the patient's efforts to breathe.
Commonly set to -1 to -2 cmH2O for pressure triggers or 2-3 liters per minute for flow triggers.
Adjusted to avoid patient-ventilator asynchrony.

Modes of Ventilation

1. Assist-Control (AC) Mode:

The ventilator delivers a set number of breaths per minute (respiratory rate).
Each breath can be triggered by the patient's effort or delivered by the ventilator at the set rate.
Delivers a full tidal volume with each breath.
Commonly used for patients who are unable to breathe adequately on their own or require full ventilatory support.

2. Synchronized Intermittent Mandatory Ventilation (SIMV) Mode:

The ventilator delivers a set number of mandatory breaths per minute.
Patients can initiate spontaneous breaths between the mandatory breaths.
Spontaneous breaths may be augmented by pressure support.
Often used for patients who have some respiratory drive but may require assistance.

3. Pressure Support (PS) Mode:

The ventilator delivers a preset level of positive pressure to support each spontaneous breath initiated by the patient.
Helps reduce the work of breathing.
Commonly used for patients who are breathing spontaneously but require assistance.

4. Continuous Positive Airway Pressure (CPAP) Mode:

The ventilator delivers a constant positive pressure throughout the respiratory cycle.
Used to maintain airway patency and improve oxygenation.
Often used in patients with sleep apnea or acute respiratory failure who can maintain their own ventilation.

5. Volume-Controlled Ventilation (VCV) Mode:

The ventilator delivers a preset tidal volume with each breath.
Ensures consistent delivery of tidal volume.
Commonly used in patients with acute respiratory failure.

6. Pressure-Controlled Ventilation (PCV) Mode:

The ventilator delivers breaths at a preset pressure level.
Allows for variable tidal volumes based on changes in lung compliance and airway resistance.
Often used in patients with acute respiratory distress syndrome (ARDS) or conditions requiring lung-protective ventilation strategies.

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Anesthesia

Cumulative Anesthetic (Off Service Anesthesia+ OMFS) Experience:
general anesthesia/deep sedation for a minimum of 300 cases.
Must involve care for 50 patients younger than 13.
A minimum of 150 of the 300 cases must be ambulatory anesthetics for oral and maxillofacial surgery outside of the operating room.

Major Surgery

Final Year Requirement:
175 major oral and maxillofacial surgery procedures on adults and children, documented by at least a formal operative note.
For the above 175 procedures there must be at least 20 procedures in each category of surgery. Sufficient variety in each category, as specified below, must be provided.
The categories of major surgery are defined as: Trauma, Pathology, Orthognathic Surgery, Reconstructive and Cosmetic Surgery
Surgery performed by oral and maxillofacial surgery residents while rotating on or assisting with other services must not be counted toward this requirement
Surgical procedures performed during foreign rotations must not count toward fulfillment of the 175 major surgical procedures.

Research

Oral or poster presentations at scientific meetings aside from program curriculum
Submission for publication of abstracts, journal articles (particularly peer reviewed) or book chapters
Active participation in or completion of a research project (basic science or clinical) with mentoring

Certifications

ACLS maintained throughout residency
PALS- certified during residency
ATLS- certified during residency

Accepted Codes by Category:

Cleft

Alveolar

42205, 42210

Lip

40700, 40701, 40702, 40720, 40761, 42260

Palate

42200, 42215, 42220, 42225, 42226, 42227, 42235, 42950

Craniofacial

Osteotomies

21137, 21138, 21139, 21150, 21151, 21154, 21155, 21159, 21160, 21172, 21175, 21179, 21180, 21181, 21182, 21183, 21184, 21260, 21261, 21263, 21267, 21268, 21275, 61557, 61559

Esthetic

Augmentation/Reduction Surgery

21120, 21125, 21127, 21208, 21209, 21270

Chemodenervation

64612

Fillers

11950, 11951, 11952, 11954

Soft Tissue Facial Non-Surgical

15780, 15781, 15782, 15783, 15786, 15787, 15788, 15789, 15792, 15793, 17004, 17106, 17107, 17108

Soft Tissue Facial Surgical

15819, 15820, 15821, 15822, 15823, 15824, 15825, 15826, 15828, 15829, 15876, 67900, 67901, 69300

Rhinoplasty

15760, 21235, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30520

Infection

Major

10061, 10121, 10140, 10180, 40801, 41005, 41006, 41007, 41008, 41009, 41015, 41016, 41017, 41018, 42300, 42305, 42310, 42320, 42700, 42720, 42725

Minor

10060, 10120, 10160, 21501, 40800, 41000, 41800, 41805, 41806

Orthognathic

Genioplasty Osteotomies

21121, 21122, 21123

Mandibular Osteotomies

21193, 21194, 21195, 21196, 21198, 21199

Maxillary Osteotomies

21141, 21142, 21143, 21145, 21146, 21147, 21188, 21206

Pathology

Biopsies

11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 20240, 20245, 21550, 40490, 40808, 41100, 41105, 41108, 42100,42400, 42405

Lesion Excision/Resection Bone Benign

20615, 21025, 21026, 21029, 21030, 21040, 21046, 21047, 21048, 21049, 21295, 21296, 41825, 41826, 41827, 41850

Lesion Excision/ Resection Malignant

11620, 11621, 11622, 11623, 11624, 11626, 11640, 11641, 11642, 11643, 11644, 11646, 17270, 17272, 17273, 17274, 17276, 17280, 17281, 17282, 17283, 17284, 17286, 21015, 21034, 21044, 21045, 21557, 40500, 40510, 40520, 40530, 41120, 41130, 41135, 41140, 41145, 41150, 41153, 41155

Lesion Excision/Resection Soft Tissue Extraoral/Benign

11420, 11421, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 17000, 17110, 21555, 42810, 42815

Lesion Excision/Resection Soft Tissue Intraoral/Benign

40810, 40812, 40814, 40816, 40820, 41110, 41112, 41113, 41114, 41116, 42104, 42106, 42107, 42120

Salivary Gland

42330, 42335, 42408, 42409, 42410, 42415, 42420, 42425, 42426, 42440, 42450

Sinus

30580, 31030, 31032

Preprosthetic

Implants

21244, 21245, 21246, 21248, 21249, D6010

Preprosthetic Surgery

40840, 40842, 40843, 40844, 40845, 41822, 41823, D4263

Preprosthetic Surgery Soft Tissue

40818, D4273, D4275, D4276, D4277, D4278

Reconstruction

Cartilage Grafting

20912, 21230

Major Bone Grafting Free Bone Grafting

20969, 20970, 20972, 21210, 21215

Microvascular

15757, 20955, 20956, 20957, 20962

Nerve Surgery

64716, 64732, 64734, 64736, 64738, 64742, 64885, 64886

Salivary Duct

42500, 42505, 42507, 42509, 42510, 42665

Soft Tissue Flap Local/Adjacent

14020, 14021, 14040, 14041, 14060, 14061

Soft Tissue Flap Regional/Nearby

15572, 15574, 15576, 15610, 15620, 15630, 15732, 40525, 40527

Soft Tissue Graft Free Skin Grafting

15120, 15121, 15220, 15221, 15240, 15241, 15260, 15261, 15770

Temporomandibular Joint

Arthroscopy

29800, 29804

Minimally Invasive

20605, 21480, 21485

Open Joint

21010, 21050, 21060, 21070, 21240, 21242, 21490

Reconstructive Autogenous

20910

Reconstructive Prothetic

21243

Tracheostomy

31600, 31601, 31603, 31605, 31610

Trauma

Dentoalveolar Trauma

21440, 21445, D7270

Mandible Fractures

21450, 21451, 21452, 21453, 21454, 21461, 21462, 21465, 21470

Midface/Upper Face Fractures, Frontal Sinus Fractures

21343, 21344

Midface/Upper Face Fractures, LeFort Fractures

21345, 21346, 21347, 21348, 21421, 21422, 21423, 21431, 21432, 21433, 21435, 21436

Midface/Upper Face Fractures, Malar Fractures

21356, 21360, 21365, 21366

Midface/Upper Face Fractures, Nasal Fractures

21310, 21315, 21320, 21325, 21330, 21335, 21336, 21337, 30020

Midface/Upper Face Fractures, NOE Fractures

21338, 21339, 21340

Midface/Upper Face Fractures, Orbital Fractures

21280, 21282, 21385, 21386, 21387, 21390, 21395, 21400, 21401, 21406, 21407, 21408

Repair of Lacerations Extraoral

12001, 12002, 12004, 12005, 12006, 12007, 12011, 12013, 12014, 12015, 12016, 12017, 12018, 12031, 12032, 12034,12035, 12036, 12037, 12041, 12042, 12044, 12045, 12046, 12047, 12051, 12052, 12053, 12054, 12055, 12056, 12057, 13120, 13121, 13122, 13131, 13132, 13133, 13151, 13152, 13153, 40650, 40652, 40654, 40830, 40831

Repair of Lacerations Intraoral

41250, 41251, 41252, 42180

Lidocaine (Xylocaine): - Maximum Dose without Epinephrine: 4.5 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine) - Toxicity: Symptoms of lidocaine toxicity may include dizziness, confusion, seizures, cardiovascular collapse, and cardiac arrest.

‍Bupivacaine (Marcaine): - Maximum Dose without Epinephrine: 2 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 3 mg/kg (with epinephrine) - Toxicity: Bupivacaine toxicity can cause significant cardiotoxicity, leading to cardiac arrhythmias, cardiac arrest, and central nervous system (CNS) effects such as seizures and dizziness.

‍Mepivacaine (Carbocaine): - Maximum Dose without Epinephrine: 4.5 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine) - Toxicity: Symptoms of mepivacaine toxicity are similar to other local anesthetics and may involve CNS and cardiovascular effects.

‍Procaine (Novocaine): - Maximum Dose without Epinephrine: 7 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: Not typically used with epinephrine - Toxicity: Procaine toxicity may present with symptoms similar to other local anesthetics but is less frequently used today due to its shorter duration and higher allergenic potential.

‍Articaine (Septocaine): - Maximum Dose without Epinephrine: 7 mg/kg (without epinephrine) - Maximum Dose with Epinephrine: 7 mg/kg (with epinephrine) - Toxicity: Articaine has a longer duration of action but can cause similar toxicity symptoms as other local anesthetics if administered excessively or if there's accidental intravascular injection.

Hypokalemia (Low Potassium Levels):

- Mild to Moderate Hypokalemia (3.0-3.5 mEq/L):

- Oral potassium supplementation: Potassium chloride tablets or liquid, 20-40 mEq orally per day in divided doses.

- Severe Hypokalemia (<3.0 mEq/L):

- IV potassium chloride: Start with 10-20 mEq/hour, under continuous cardiac monitoring.

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‍Hyperkalemia (High Potassium Levels):

- Mild Hyperkalemia (5.1-6.0 mEq/L):

- Dietary potassium restriction and discontinuation of potassium supplements.

- Severe Hyperkalemia (>6.0 mEq/L or with ECG changes):

- Calcium gluconate or calcium chloride IV to stabilize cardiac membranes.

- Insulin with glucose IV, beta-agonists (e.g., albuterol), or sodium bicarbonate to shift potassium into cells. - Loop diuretics or exchange resins (e.g., sodium polystyrene sulfonate) to enhance potassium removal.

Hypocalcemia (Low Calcium Levels):

- Mild Hypocalcemia (8.0-8.5 mg/dL):

- Oral calcium supplements: Calcium carbonate or calcium citrate, doses vary based on elemental calcium content.

- Severe Hypocalcemia (<8.0 mg/dL or symptomatic):

- IV calcium gluconate or calcium chloride, dosages depend on severity and symptoms.

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‍Hypercalcemia (High Calcium Levels):

- Mild Hypercalcemia (10.5-11.9 mg/dL):

- Hydration with IV saline and loop diuretics.

- Severe Hypercalcemia (>12 mg/dL or symptomatic):

- Bisphosphonates, calcitonin, or corticosteroids may be used for severe cases.

Hypomagnesemia (Low Magnesium Levels):

- Mild to Moderate Hypomagnesemia (1.2-1.8 mg/dL):

- Oral magnesium supplements: Magnesium oxide, magnesium citrate, or magnesium glycinate, dosages vary.

- Severe Hypomagnesemia (<1.2 mg/dL or symptomatic):

- IV magnesium sulfate, doses vary based on severity and response.

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‍Hypermagnesemia (High Magnesium Levels):

- Mild to Moderate Hypermagnesemia (2.5-3.0 mg/dL):

- Discontinuation of magnesium-containing medications.

- Severe Hypermagnesemia (>3.0 mg/dL or with symptoms):

- IV calcium gluconate for severe symptoms.

- Dialysis may be necessary in extreme cases.

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