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Neo/Peds MV
Neonatal and Pediatric Mechanical Ventilation
| Term | Definition |
|---|---|
| Ventilator tube compliance for neonates and peds | low |
| Settings that control ventilation | PIP, RR, I-time, Inspiratory Flow |
| PIP or PMAX | Primary control for ventilation |
| PIP or PMAX has an effect on what? | Tidal volume, mean airway pressure |
| Initial PIP range | 20-30 cmh20 |
| PIP for Full term infant | 20-25 cmh20 |
| PIP for premies or IRDS | 25-30 cmh20 or less than gestational age |
| What is the major cause of Barotrauma | A high PIP |
| What does frequency directly effect? | minute volume, paco2, and mean airway pressure |
| When do you choose to manipulate frequency on the ventilator? | comes 2nd after adjusting PIP |
| Initial Frequency Range | 20-40 Breaths/minute |
| Low Birth Weight Infant Frequency | 30-40 Breaths/minute |
| Term Infant Frequency | 20-30 Breaths/minute |
| Children Frequency Range | 12-20 Breaths/minute |
| Inspiratory time affects what? | Primary control for I:E, affects inspiratory plateau time, mean airway pressure, intrapleural pressures |
| Initial I time Infants | 0.25- 0.50 seconds |
| Initial I time for children | 0.5-0.7 seconds |
| Initial Inspiratory flow | 5-10 liters |
| What does inspiratory flow affect? | rise time and pressure wave pattern, directly affects the mean airway pressure |
| When to use a higher flow rate? | decrease atelectasis and to increase distribution of ventilation |
| When to use a lower flow rate? | help decrease barotrauma and decrease chances for pneumothorax |
| What is an indication of inadequate flow? | increased respiratory effort and wide pressure fluctuations are indications of inadequate flow |
| what is an indication of excessive flow? | inadvertent peep |
| What should be done if a leak occurs | Do not increase PIP or flow- find and correct leak |
| Mean Airway Pressure (Paw) | the average pressure transmitted to the airway from the beginning of one breath to the beginning of the next breath |
| Controls that directly effect Paw | PIP, F, IT, PEEP, and to a small degree flow |
| What should Paw be kept at? | 10-14 cmh20 |
| Oxygenation Settings | FIO2 and PEEP |
| FI02 Initial setting | 30-60% Or same level |
| PEEP Initial setting | 3-5 cmh20, Range 3-8 cmh20 Or same level |
| Mode in the Initial Stage of ventilation | Any mode is acceptable for the initial stage of ventilation. IMV/SIMV for neonates |
| What is checked first in Phase 2- Managing the patient? | Mode |
| Oxygen Index of 20 or less | Acceptable |
| Oxygen Index of >20 | pt needs 02 therapy |
| Oxygen Index of 30 or > | use high frequency, jet, or oscillator to ventilate pt |
| Oxygen Index of 40 or > | Use ECMO |
| Formula for Oxygen Index | Paw X Fi02 / Pa02 |
| To correct ventilation problems what should be adjusted first? | PIP |
| To decrease PaC02 what do you do to PIP? | Increase PIP |
| To increase PaC02 what do you do to the PIP? | Decrease PIP |
| High PIP of >35 will put the pt at risk for what? | barotrauma, pulmonary air leaks, and bronchopulmonary dysplasia |
| As lung compliance decreases, PIP should be? | Increased to maintain Vt |
| As lung compliance improves, PIP should be | Decreased to avoid increased Vt and pneumothorax |
| TCT Formula | 60/F |
| Inspiratory Time Formula | TCT/(I+E) |
| Expiratory Time | TCT-Inspiratory Time |
| Greatest Effect on Mean Airway Pressure | PEEP |
| What are the positive effects of PEEP? | Increases FRC, decreases shunting, recruits collapsed alveoli, and improves oxygenation |
| Primary indication for PEEP | Pa02 < 50torr on Fi02 > 60% |
| Why is excessive PEEP(>10cmh20) poorly tolerated in infants? | decreases venous return, causes hyperinflation & C02 retention, & increases deadspace along with WOB |
| If Paw is greater than 20 cmh20 | Peep should be decreased to reduce the risk of barotrauma |
| What causes patient dys-synchrony? | inadequate oxygenation, flow, tidal volume, or rate |
| Sedative agents | Valium, Versed, Ativan, Romazicon |
| Chloral hydrate | non-barbiturate hypnotic |
| Narcotic analgesic | Given for pain Ex: Morphine sulfate, fentanyl citrate |
| Onset and duration of action for neuromuscular blocking agents | Rapid onset of 1 minute and short duration of action (7-12 minutes) |
| Weaning trial, all patients should be in what mode? And have what kind of ABG | IMV, acceptable values for ABG |
| Decrease PIP in increments of | 1-2 to 25 cmh20 |
| Decrease RR in increments of | 3-5 to reach 10-12 |
| Decrease Fi02 in increments of | 2-5% |
| Decrease PEEP to | < 5cmh20 in increments of 1 at a time |
| Minimal Acceptable ranges for a CPAP trial | PIP: < or = 25cmh20 Rate: < or = 10-12 per min Fio2: < or = .40 PEEP: < or = 5 cmh20 |
| RR is adjusted how often during weaning | Adjusted every 15-20 minutes for the first hour to insure adequate oxygenation |
| Resume Mechanical ventilation if any of the following occur: | Tachycardia or bradycardia, retractions or nasal flaring, agitation or exhaustion, increased Pac02, increased RR, seesaw breathing, tracheal tug/ shift |
| Tidal volume settings in volume control for infants and children | Infants: 4-8 mL/Kg Children: 6-10 mL/Kg |
| Corrected Vt formula | Set Vt (-) compressible volume |
| Compressible volume formula | PIP-PEEP X Tubing compliance factor |
Created by:
bbrashears0004
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