Daily Low Tidal Volume Ventilation Data Collection Tool

Enter for all patients. Mechanical ventilation is defined as receiving ventilator support via a subglottic secretion drainage endotracheal tube or tracheostomy tube.

• Patients treated with noninvasive ventilation are counted as "N."
• Enter "Y" if the patient is currently intubated/trached and mechanically ventilated.
• Enter "N" if the patient is NOT currently intubated/trached and mechanically ventilated.
• Enter "E" if there is no patient in the bed.

For any specific patient, if the patient is not currently intubated/trached AND on mechanical ventilation, STOP. Do not enter any more information regarding that bed for this date.

Enter for all patients receiving mechanical ventilation.

Enter 1, 2, or 3 on the data collection tool depending on which type of vent mode is present at the time of observation.

Enter 1 – if the patient’s ventilator is set to one of the following Volume-Cycled Modes:

• Continuous Mandatory Ventilation (CMV).
• Assist Control (AC).
• Synchronized Intermittent Mandatory Ventilation (SIMV).
• Volume Support (VS).
• Pressure Regulated Volume Controlled (PRVC).

Enter 2 – if the patient’s ventilator is set to one of the following Pressure-Cycled Modes:

• Pressure Support (PS).
• Continuous Positive Airway Pressure (CPAP).
• Pressure Control (PC).
• Airway Pressure Release Ventilation (APRV).
• Bilevel Ventilation.

Enter 3 – if the patient’s ventilator is set to one of the following Other Modes: 

• Proportional Assist Ventilation (PAV).
• Adaptive Support Ventilation (ASV).
• Inverse Ratio Ventilation (IRV).
• High Frequency Oscillatory Ventilation (HFOV).
• Extracorporeal Membrane Oxygenation (ECMO).
• Other.

If “1” or “2” for any specific patient, continue to next column.
If “3” for any specific patient, skip ahead to the last two columns:
“Does patient have a risk factor for ARDS?” AND “Does the patient have ARDS?”

Evaluate daily for patients receiving mechanical ventilation and whose vent mode equals 1 or 2.

Depending of which measurement your unit uses, enter EITHER centimeters OR inches. 

Pick one.

• Enter the patient’s height in centimeters in the “cm” column if your unit uses centimeters.
• Enter the patient’s height in inches in the “in” column if your unit uses inches.

Evaluate daily for patients receiving mechanical ventilation and whose vent mode equals 1 or 2.

• Enter "M" if the patient is male.
• Enter "F" if the patient is female.

Actual Tidal Volume: What is the tidal volume at the time of observation?

Quick reference tables are available on the last page of this document to calculate predicted body weight for tidal volume.

Evaluate daily for patients receiving mechanical ventilation and whose vent mode equals 1 or 2.

Enter the actual tidal volume in milliliters (mL). Use the preset tidal (prescribed) volume if the mode is one of the volume cycled modes (from Vent Mode question above).

If the mode is one of the pressure cycled moves (from Vent Mode question above), enter the approximate expired tidal volume.

If you entered "3" for the ventilator, you should NOT be collecting this data. (Please refer to instructions for Vent Mode on page 4.)

Evaluate daily for patients receiving mechanical ventilation and whose ventilator mode equals 1, 2, AND 3.

If the patient has one or more of the following, enter "Y," otherwise enter "N."

• Pneumonia.
• Sepsis, severe sepsis, or septic shock, not secondary to pneumonia.
• Aspiration.
• Trauma.
• Other risk factor (i.e., massive transfusion, acute pancreatitis, etc.).

ALL ventilator modes (1, 2, and 3) should respond to this question.