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Today's article is about, “Quick Tip for Families in Intensive Care: Why ICU Increased Ventilator Breaths per Minute (BPM) from 14 to 18 — Explained!”

You may also watch the video here on our website https://intensivecarehotline.com/ventilation/quick-tip-for-families-in-intensive-care-why-icu-increased-ventilator-breaths-per-minute-bpm-from-14-to-18-explained/ or you can continue reading the article below.

Quick Tip for Families in Intensive Care: Why ICU Increased Ventilator Breaths per Minute (BPM) from 14 to 18 — Explained!

“Why ICU increased ventilator breaths per minute from 14 to 18 — Explained!”

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

So, in today’s video, I have a question from one of our members, Maria, who says:

“Hi Patrik,

Thank you so much for the daily updates.

One question that I have for now:

The ventilator was set at 14 breaths per minute for my mom for numerous days now. What would warrant a change to 18 breaths per minute? Are there changes in my mom’s blood gas values that would necessitate a change in breaths per minute?

If so, what are the specific values and please explain. ICU nurse mentioned that CO2 was the cause for the changes from 14 to 18. Please clarify how this works.

Thanks again.

From, Maria.”

So, it’s a great question, Maria, and this is a very important topic for anyone with a loved one on a ventilator in intensive care.

What does ventilator breaths per minute (BPM) actually mean?

The breath per minute setting on a ventilator determines how many mechanical breaths per minute the ventilator delivers to the patient on a regular basis, minute by minute. It means the ventilator delivers 14 breaths per minute, 18 breaths per minute means 18 breaths per minute.

The setting can be adjusted by the ICU team depending on your loved one’s arterial blood gas  results, clinical condition, and as you’ve already mentioned, CO2, also known as carbon dioxide levels.

So, first off, your mom would be in a controlled ventilation mode, which means she’s probably either an ACV (assist control ventilation) mode or an SIMV mode (synchronized intermittent mandatory ventilation mode) so that the ventilator is basically doing all the work.

So, the main reason for increasing the ventilator breaths per minute is to reduce elevated CO2 or carbon dioxide levels in the blood. When the respiratory rate or breaths per minute is increased, it helps the patient breathe out more CO2 or carbon dioxide levels, leading to lower carbon dioxide levels in the blood and helping to balance the blood pH.

If the ICU team noticed a high CO2 level in your mom’s arterial blood gas, that’s known as hypercapnia. The next step here would be to increase the breaths per minute from 14 to 18 to help blow off the CO2.

So, what are the blood gas values that guide a change like this?

An arterial blood gas is also known as an ABG and it measures key values like PCO2, the partial pressure of carbon dioxide in the blood, normal range is usually 35 to 45 mmHg. If PCO2 is above 45 mmHg, the patient is retaining CO2, breaths per minute need to be increased. If CO2 is above 45 mmHg, patients could get confused, drowsy, but could also change their pH level.

Normal range of pH is 7.35 to 7.45 and a patient with high CO2 could become acidotic, which means pH would get lowered.

Next, PO2 pressures, partial pressure of oxygen, measures the oxygenation in the arterial blood gas, normal range is 80 to 100 mmHg. HCO3 is bicarbonate, a buffer that helps regulate pH, normal range is 22 to 26 mmol/L. 

So, if your mom’s PCO2 was high, for example, 55 to 60 mmHg and pH was low, around 7.28 to 7.32, the ICU team would likely increase the breaths per minute to help normalize those values.

How it works in simple terms?

More breaths per minute, more CO2 is removed, CO2 levels go down. Fewer breaths per minute, less CO2 is removed, CO2 levels rise. It is a fine balance, and the devil is as always in the detail in ICU. Too much ventilation can cause respiratory alkalosis, so CO2 would be too low. While too little can cause respiratory acidosis, CO2 is too high. That’s why the ICU team monitors ABGs closely and adjusts the ventilator settings accordingly.

So, what is it that families in intensive care need to know?

If your loved ones’ ventilator settings are being changed frequently, it’s important to ask for the latest ABG results, but also for things like chest X-rays, also the ventilator settings and understand what they mean. You can ask: What are the latest ABG results? What are the current ventilator settings? What is the current PCO2 and pH? What is the plan to wean ventilation safely? What are current chest X-rays showing?

Understanding these values and diagnostics helps you advocate for your loved one’s best care and treatment and ensures the ICU team is managing ventilation optimally for your loved one.

In summary, Maria, your mom’s ventilator breaths per minute was likely increased from 14 to 18 because her CO2 was too high and the ICU team is trying to help her blow off that excess CO2 to restore a normal blood gas balance. This is a normal part of ventilator management, but it’s essential that you stay informed and ask for explanations every step of the way.

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 support@intensivecarehotline.com with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have from this video.

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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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