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Neo/Peds MV

Neonatal and Pediatric Mechanical Ventilation

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