“Why do ventilator breaths per minute (BPM) change in ICU? CO2 levels 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 by making 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, today’s question comes from Maria, who says:
“Hi Patrik. Thank you for the daily updates,” and Maria is one of our members where she gets daily updates when we review her
mom’s medical records. We can do the same for you because we have a membership for families of critically ill patients in intensive care at intensivecarehotline.com.
So, Maria says:
“Hi Patrik,
Thank you for the daily updates.
One question for now:
The ventilator breaths per minute was at 14 per minute for numerous days. 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 from 14 to 18?
If so, what are the specific values and please explain. Respiratory mentioned CO2, which is carbon dioxide, as
the cause of the change from 14 to 18, please clarify how this works.
Thanks again.
From, Maria.”
That’s a great and very important question, Maria, and it’s one that families in intensive
care ask frequently when their loved one is on a ventilator in ICU.
So let’s break this down so you can understand exactly what’s going on and so that you’re not left in the dark by the ICU team, which is what happens all the time, that ICU teams are not even telling you half of the story of what’s going on until we come in and bring in transparency by asking the right questions, by looking at medical records, or by talking to doctors and nurses directly, and by going through a series of questions that will inevitably open your eyes because I ask 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.
So, what does breaths per minute mean on a ventilator? Breaths per minute or respiratory rate is the number of breaths the ventilator delivers per minute.
In your mom’s case, it was 14 breaths per minute for several days, and now it increased to 18 breaths per minute. This setting directly impacts how much CO2, also known as carbon dioxide, your mom is breathing out, and how much oxygen, which is known as O2, she is
receiving.
So, why would the ICU team increase the ventilator breaths per minute from 14 to 18 or increase the breaths per minute in general? The most common reason to increase the breaths per minute is to reduce CO2 levels in the blood. Let’s look at this through the lens of arterial blood gas results, also known as ABG. ABG typically shows pH 7.35 to 7.45, PCO2 (carbon dioxide), 35 to 45 mmHg, PO2 (oxygen), 80 to 100 mmHg, HCO3 or the bicarbonate is 22 to 26.
If your mom’s PCO2 was
too high, say about 45 mmHg, the ICU team might increase the ventilator rate breaths per minute to help her breathe out or exhale more CO2. More breaths per minute, more CO2 elimination, improvement in the pH balance. If she was in respiratory acidosis, too much CO2 will lower the pH levels.
So let’s give an example of a blood gas change. For instance, if your mom’s ABG showed pH 7.29, which is low,
and PCO2 is 55 mmHg, which is high, the respiratory therapist or doctor or ICU nurse would likely increase the breaths per minute from 14 to 18 breaths to help blow off excess CO2, aiming to bring the pH back to normal around 7.35 to 7.45.
When would they lower the breaths per minute? If the CO2 drops too low, for example, PCO2 is less than 35 mmHg, it can cause respiratory alkalosis, meaning the
patient is blowing off too much CO2. In that case, the team might reduce the breaths per minute or adjust other ventilator settings like tidal volumes or pressure support or sometimes even PEEP (Positive End-Expiratory Pressure).
So, what can you do as a family member? Number one, you must get access to all medical records unequivocally, full stop. You must get access to all medical records and
that’s your right, it’s not a privilege. Then you’ve got to get set up with the right questions to ask, which is what we help you with here at intensivecarehotline.com.
The biggest challenge for families in intensive care is 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.
So, ask the ICU team for all access to
medical records. Ask the ICU team for your mom’s latest arterial blood gas result and look specifically at PCO2 (carbon dioxide levels in the blood), pH (the acid base balance), the PO2 (the oxygen level in the blood), the ventilator settings, the mode, the tidal volume, FIO2 (Fraction of Inspired Oxygen), PEEP (Positive End-Expiratory Pressure) rate. Is it volume control? Is it pressure control? Understanding these values helps you see why changes are made and whether your mom is improving or
not.
So what’s next? If your mom is slowly improving, the goal is to wean her off the ventilator gradually by reducing the breaths per minute, step by step, introducing spontaneous breathing trials (SBTs) using BIPAP (Bi-level Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure), or high flow nasal cannula as a bridge, incorporating chest physiotherapy and early mobilization to strengthen her lungs and muscles. This stepwise approach reduces the risk of reintubation and speeds up ventilator weaning safely.
But here’s a bonus tip, if your mom’s CO2 is rising, it could also be because she’s on too much sedation and on too many opiates. Because I’ll tell you why, if she’s on too much sedation or too many opiates, and she’s on a rate
of 14 breaths per minute, without too much sedation and without too many opiates, she might breathe up automatically. But because one of the main side effects of sedation and opiates is respiratory depression, she may not breathe up naturally.
Therefore, you got to increase the rate mechanically. It’s much better to have increased the rate naturally and organically, which is why you also need to ask
whether she’s on too much sedation or too many opiates. This stepwise approach and by asking the right questions, reduces the risk of reintubation and speeds up when weaning safely.
In summary, the increase from 14 to 18 breaths per minute was most likely to help your mom clear excess CO2, carbon dioxide from her blood. This is guided by arterial blood gas values, mainly PCO2 and pH. Once CO2 levels
and pH normalizes, the ventilator rate can often be reduced again as part of weaning.
Once again, ask whether she’s on too much sedation, too many opiates, and what these opiates and sedatives are, and then reach out to us. We’ll help you there to advocate for the best care and treatment for your mom.
If you want to learn more about ventilator management, weaning, how to interpret blood gases, how to interpret medical records, check out our articles and videos at intensivecarehotline.com.
If you need one on one support, contact me directly for a confidential consultation so your loved one always gets best care and treatment. Contact us at
intensivecarehotline.com today.
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.
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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.
