Mechanical ventilation reference for prolonged casualty care on transport ventilators such as the SAVe II, EMV+ 731, and Hamilton-T1. Covers initial mode, tidal volume, rate, FiO2, PEEP and I:E settings, the SOAPME pre-intubation setup mnemonic, the DOPES deterioration troubleshooting mnemonic, lung-protective ventilation targets, oxygenation strategy, ARDS and blast lung management, and weaning readiness. Aligned with the JTS Airway Management and Mechanical Ventilation CPG.
Prolonged Casualty Care
Vent Management
SAVe II · EMV+ 731 · Hamilton-T1
Managing a casualty already on a transport ventilator. Intubation and surgical airway are in the PFC Procedures module.
Initial Settings
ModeVolume A/C
Volume-controlled assist/control is the default for transport vents and the simplest to manage.
Tidal volume6-8 mL/kg PBW
Use predicted body weight from height, not actual weight. Target 6 mL/kg for ARDS or blast lung.
Rate12-16 / min
Titrate to EtCO2 and pH. Increase for metabolic acidosis or to clear CO2.
FiO21.0, then wean
Start 100 percent, wean to the lowest FiO2 holding SpO2 92-96 percent. High FiO2 wastes finite oxygen and risks toxicity.
PEEP5 cmH2O
Increase in steps of 2-3 for refractory hypoxemia. Watch blood pressure: high PEEP drops preload and can crash a hypovolemic casualty.
I:E ratio1:2
Lengthen expiratory time (1:3, 1:4) for obstructive physiology or air trapping.
SOAPME — Setup Before You Tube
S
Suction
Working, mounted, and within reach before you start.
O
Oxygen
Source confirmed and BVM connected and functional.
A
Airway
Tube of the planned size, one size smaller staged, bougie, blade, backup supraglottic.
P
Positioning + Pharmacy
Casualty positioned (ear-to-sternal-notch), induction and paralytic drawn and labeled.
M
Monitors
SpO2 and continuous EtCO2 capnography on before the attempt.
E
EtCO2 + Equipment
Confirmation method ready, ventilator powered and pre-set so you can transition straight to it.
DOPES — Deterioration on the Vent
D
Displacement
Tube migrated or out. Check depth mark and capnography waveform. No waveform means no airway until proven otherwise.
O
Obstruction
Kink, mucus plug, or biting. Pass a suction catheter; if it will not pass, the tube is obstructed.