Key messages

• Many patients can be safely mechanically ventilated at respiratory rates similar to their spontaneous rate, but alteration may be required depending upon the following.

• Acceptable Paco2: eucapnia may require high respiratory rates and so care must be taken to avoid ventilator-induced lung injury.

• Metabolic rate: an increase will require a higher alveolar minute ventilation, possibly by respiratory rate adjustment.

• Physiological dead-space: this governs the amount of the tidal breath that results in alveolar ventilation.

• Tidal volume: together with physiological dead-space and respiratory rate, this determines alveolar minute ventilation.

• Mode of ventilation and level of spontaneous respiration: increasing spontaneous ventilation will often allow a reduction in the respiratory rate set.

• Respiratory time constant: this will indicate the risk of the occurrence of auto-PEEP which can be particularly troublesome at higher respiratory rates with shortened expiratory times.

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