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Basic Pediatric Ventilation: A 10 Slide Production by James Rubino USAF RT

This document provides an overview of basic pediatric ventilation. It discusses guidelines for CPAP use in children and common noninvasive ventilation modes. While adult ventilation protocols can be used after the first few months of life, there is no established evidence on best mechanical ventilation modes for pediatrics. Common mistakes include using inadequate inspiratory time and distending pressure. Initial pediatric ventilator settings are provided along with target blood gas ranges and indications for ventilatory support. Pressure ventilation is discussed as a way to prevent lung injury, along with potential problems with pressure support modes.

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112 views10 pages

Basic Pediatric Ventilation: A 10 Slide Production by James Rubino USAF RT

This document provides an overview of basic pediatric ventilation. It discusses guidelines for CPAP use in children and common noninvasive ventilation modes. While adult ventilation protocols can be used after the first few months of life, there is no established evidence on best mechanical ventilation modes for pediatrics. Common mistakes include using inadequate inspiratory time and distending pressure. Initial pediatric ventilator settings are provided along with target blood gas ranges and indications for ventilatory support. Pressure ventilation is discussed as a way to prevent lung injury, along with potential problems with pressure support modes.

Uploaded by

jcrubino
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Basic Pediatric Ventilation

A 10 Slide Production by
James Rubino USAF RT
CPAP
• Same guidelines as adults
• Used for weaning
• Replaced by NPPV
▫ BiLevel
▫ BiPAP
▫ APRV
• Not well tolerated in children 1-3 yrs of age
No Corpus of Evidence Based Conclusions on
Best MV Modes Yet
• After first few months of life strategies that
resemble adult ventilation protocols are used
Most Common Mistakes
• Inadequate Ti –
▫ for significant lung disease start with 0.8 seconds
• Inadequate Distending Pressure
▫ PIPs of 30-35 cmH2O often necessary for
adequate alveolar recruitment
▫ Evaluation of Ventilation and Oxygenation
 Chest Rise and Fall
 Breath Sounds
 Chest X-Ray
 ABGs
INDICATIONS FOR VENTILATORY SUPPORT
Indications Description Example
Acute Respiratory Failure Inability of Patient to ARF 1 = PaO2
(ARF) maintain adequate PaO2 ARF 2 = PaCO2
PaCO2 and potentially
pH
Impending ARF Respiratory Failure is Neuromuscular Diseases
Immanent – Pt barely Status Asthmaticus
able to maintain
borderline PaO2 or
PaCO2 & pH
Prophylactic Ventilatory Conditions where there is Brain or Heart Injury,
Support risk of respiratory failure Major Surgery, Shock,
or compromise Smoke Injury, Coma
Hyperventilation Ventilator support Acute Head Injuries
Therapy needed to control and
manipulate PaCO2 to
lower then normal levels
Pediatric Initial Settings
Parameter Pediatric Parameter Pediatric
Settings Settings
Vt 6 -10 ml/kg iT 0.5 – 1.5 sec
PIP 25 – 30 cmH2O Flow 2 x 3 MV
Paw 5 -15 cmH2O Time exp 0.5 – 1.5 sec
PEEP 4 – 10 cmH2O I:E 1:1 to 1:4
Frequency (Rate) 12 -25 bpm FiO2 .4 - .5
Target ABG’s
PaO2 70 – 100 mmHg
PaCO2 35 -45 mmHg
pH 7.3 – 7.45
SaO2 > 92%
Pressure Ventilation
• Used to prevent MV associated lung injury
• Advantages
▫ Immediate rise to PIP
 Permits better gas distribution over time
▫ Decelerating Flow wave
 More protective versus VV Constant Flow
▫ Might Compensate for Leaks better
Pressure Support Problems
• Premature PS termination
▫ ETT < 4.5 create excessive resistance
▫ Watch for decreased Vt delivered
• Failure of Flow Cycle due to ET tube leaks
The End
Taken and Adapted from
Ventilator Management:
A Bedside Reference
By Dana Oakes and Sean Shortall

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