NEO - Conventional Mechanical Ventilation ppt (1/20)

Goals and Objectives (3)

1. Safety (gas exchange, lung protection)

2. comfort (synchrony, healthy ratio of vent support to own pt effort)

3. liberation (minimize vent time + adverse events)

Clinical indications

1. neurological issues (hypotonia, apnea, seizures (airway protection!), central hypoventilation, tumors, TBI, drug overdose)

   1. neuromuscular disorders (MG, GB, SCI, diaphragm paralysis)

2. Surgical (omphalocele/gastroschitis, neuro-tube defects, postops)

3. cardiovascular (sepsis (hypotension due to vasodilation), PPHN, cardiomyopathy, shock)

common situations for mech ventilation

1. restrictive (RDS, CDH, pneumonia, ARDS, scoliosis, CW, rib cage issues)

2. obstructive (MAS, BPD, choanal atresia, airway disorders, LTB, epiglottitis, tracheomalacia, asthma, CF, bronchiolitis)

3. pulmonary hypoplasia (CDH, oligohydarminos)

Conventional mechanical ventilation

Establish normal pattern of RR and VT for required Ve.

Changing RR = changes I:E and Ve.

CMV

All breaths MANDATORY, meaning every breath will breathe in the set VT, including VCCMV → VCAC and PCCMV → PCAC

IMV

MANDATORY and SPONTANEOUS breaths, mandatory are set while the spontaneous are not breathed at set rate. VC-IMV → VCSIMV and PC-IMV → PC-SIMV

CSV

all breaths are SPONTANEOUS, supported with a backup rate if apnea happens. PC-CSV → CPAP PSV

Drager VN500

PC-AC: every insp effort triggers a synchronized mandatory breath through setting Pinsp or variable P controls Vt

PC-SIMV: spont breaths supported w/ PS and are NOT volume guaranteed as Pt controls the Ti, volume and RR of spont breathing. Set RR does NOT set a back up rate.

VG: volume guarantee, allowing constant VT w/ changing comp + res, reducing pressure load to lungs

Initial settings for premature infant
(RR, VT, PIP, Ti, PEEP, FiO2, Trig, PS)

Weight: <2kg

RR: 30-50
Vt: 4-6mL/kg
PIP: 18-25 (adjust to target VT)
Ti: 0.25-0.4
PEEP: +3-5
FiO2: 10% higher than pre intubation
Trig: 0.2-0.5
PS: 6-10 (adjust to target VT)

Initial setting for infant
(RR, VT, PIP, Ti, PEEP, FiO2, Trig, PS)

Weight: 2-10kg

RR: 25-40
VT: 5-6mL/kg
PIP: 18-25 (adjust to target VT)
Ti: 0.4-0.5
PEEP: +5-7
Trig: 0.20-0.5
PS: 6-10 (Adjust to target VT)

Initial settings for toddler/child

Weight: 10-40kg

RR: 15-25
VT: 6-8mL/kg
PIP: 18-25 (adjust to target VT)
Ti: 0.5-0.8
PEEP: +5-7
Trig: 1.0-2.0
PS: 6-10 (adjust to target VT)

FiO2 for preterm, term and PPHN risk pt

Preterm: 88-92%

Term: 90-95%

PPHN risk: 92-97%

Alarm settings

High MV: 3x set MV

Low MV: 20% set MV

To increase or decrease PaO2

Increase or decrease FiO2, PEEP or PIP

To increase or decrease PaCO2

Decrease or increase RR, PIP, VT

What equals PS above PEEP?

Nava level * (edi peak - edi min)

Do you always humidify your pt?

ALWAYS to 37C.

When do you change pt circuit

Q30 or when soiled/malfunctioning

Complications of mech vent

1. trauma (volu, atelec, baro)

2. reduced QT

3. O2 toxicity

4. hypo/erventilation

DOPE

troubleshooting mechanism

Displaced tube
Obstruction
Pneumothorax
Equipment