Ventilator tube compliance for neonates and pedslow
Settings that control ventilationPIP, RR, I-time, Inspiratory Flow
PIP or PMAXPrimary control for ventilation
PIP or PMAX has an effect on what?Tidal volume, mean airway pressure
Initial PIP range20-30 cmh20
PIP for Full term infant20-25 cmh20
PIP for premies or IRDS25-30 cmh20 or less than gestational age
What is the major cause of BarotraumaA 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 Range20-40 Breaths/minute
Low Birth Weight Infant Frequency30-40 Breaths/minute
Term Infant Frequency20-30 Breaths/minute
Children Frequency Range12-20 Breaths/minute
Inspiratory time affects what?Primary control for I:E, affects inspiratory plateau time, mean airway pressure, intrapleural pressures
Initial I time Infants0.25- 0.50 seconds
Initial I time for children0.5-0.7 seconds
Initial Inspiratory flow5-10 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 occursDo 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 PawPIP, F, IT, PEEP, and to a small degree flow
What should Paw be kept at?10-14 cmh20
Oxygenation SettingsFIO2 and PEEP
FI02 Initial setting30-60% Or same level
PEEP Initial setting3-5 cmh20, Range 3-8 cmh20 Or same level
Mode in the Initial Stage of ventilationAny 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 lessAcceptable
Oxygen Index of >20pt 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 IndexPaw 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 beDecreased to avoid increased Vt and pneumothorax
TCT Formula60/F
Inspiratory Time FormulaTCT/(I+E)
Expiratory TimeTCT-Inspiratory Time
Greatest Effect on Mean Airway PressurePEEP
What are the positive effects of PEEP?Increases FRC, decreases shunting, recruits collapsed alveoli, and improves oxygenation
Primary indication for PEEPPa02 < 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 cmh20Peep should be decreased to reduce the risk of barotrauma
What causes patient dys-synchrony?inadequate oxygenation, flow, tidal volume, or rate
Sedative agentsValium, Versed, Ativan, Romazicon
Chloral hydratenon-barbiturate hypnotic
Narcotic analgesicGiven for pain Ex: Morphine sulfate, fentanyl citrate
Onset and duration of action for neuromuscular blocking agentsRapid 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 ABGIMV, acceptable values for ABG
Decrease PIP in increments of1-2 to 25 cmh20
Decrease RR in increments of3-5 to reach 10-12
Decrease Fi02 in increments of2-5%
Decrease PEEP to< 5cmh20 in increments of 1 at a time
Minimal Acceptable ranges for a CPAP trialPIP: < or = 25cmh20 Rate: < or = 10-12 per min Fio2: < or = .40 PEEP: < or = 5 cmh20
RR is adjusted how often during weaningAdjusted 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 childrenInfants: 4-8 mL/Kg Children: 6-10 mL/Kg
Corrected Vt formulaSet Vt (-) compressible volume
Compressible volume formulaPIP-PEEP X Tubing compliance factor