9 - Pediatric Mechanical Ventilation

indications for pediatric MV

• apnea

• hypoxemia

• hypercapnia

• respiratory distress

assessment for initiation of MV

• ABG

• S_pO₂

• CXR

• lung mechanics

MV modes

• neonatal

• CMV

• IMV

• CSV (ie, PS, NAVA)

MV modes

• pediatric

• PCV

• VCV

nonconventional ventilation

• HFOV

  • active inspiration and exhalation

• HFJV

  • passive exhalation

  • for BPF

lung protection strategies

• avoid volu-/baro-/atelectrauma

• titrate PEEP, allow permissive hypercapnia, surfactant

• proning improves V/Q and C_L in ARDS

ventilating neonates with cardiac lesions

• ductal lesions

balance circulation

ventilating neonates with cardiac lesions

• right side defects

• increase pulmonary flow with O₂

• lower CO₂

ventilating neonates with cardiac lesions

• left side defects

• limit O₂

• allow mild acidosis to limit flow

weaning and extubation criteria

• resolve disease

• spontaneous breathing

• airway protection

• post-extubation: CPAP, NIPPV, HFNC

complications of MV

• air leaks

• BPD

• ROP

HFOV

active inspiration and exhalation via oscillator with small V_T at high frequency (3-5 Hz)

benefits of HFOV

• prevent atelec-/volutrauma with constant MAP

• improve oxygenation, especially in neonatal RDS and ARDS

drawbacks of HFOV

• may not benefit some populations

• may have longer ICU stay

• must monitor hemodynamics

clinical application of HFOV

• lung recruitment

• adjust MAP above MV

• monitor amplitude, frequency, i-time, oscillations, x-ray (8-9 ribs), MAP alarms

HFJV

short, high pressure jet bursts during inspiration with passive exhalation (auto-PEEP)

benefits of HFJV

• good for air leaks (PIE, pneumothorax)

• good for CO₂ clearance

• good for post congenital heart surgery

drawbacks of HFJV

• limited data on effectiveness

• air leaks or tracheal trauma

clinical application of HFJV

• rescue treatment

• initial settings

  • i-time 0.02 sec

  • frequency 360

  • adjust ∆P

monitoring HFJV

• ABG

• air leaks

• auto-PEEP