Ve ntilation
Previous: see airway
Provide oxygen
LFNP
HM
HM with rebreather
Non-Invasive Ventilation
Mouth-to-mask OR
Bag-valve-mask
CPAP: Continuous positive airway pressure
BiPAP: Bilevel pos airway pressure (CPAP with pressure support)
NPV: Negative Pressure Ventilation (iron lung)
(if difficulty ? airway problem e.g. foreign body ?circuit problem
Invasive ventilation
via ET (N/O), Tracheostomy, needlecric... see airway
Volume limited/Pressure limited
Adjusting ventilator settings
Problems
Oxygenation (↓O2): ↑FiO2, ↑MAP (↑PIP or ↑PEEP or ↑Ins time i.e. I:E) if chest hypoexpanded PEEP may be best
Ventilation (↑CO2): ↑minute volume through ↑RR OR ↑TV (↑PIP or ↓PEEP).
If reducing things ?PIP/FiO2 first to reduce barotrauma/oxygen free radicals
Initial settings
PIP 18
PEEP 5
Rate: neonate 25, infant/child 20, adolescent 15
FiO2 start at 1.0 the quick wean to 0.6 and titrate from there
I:E 1:2 (need longer in asthma to allow expiration, then shorter / reversed in hypoxia
(I time will depend on rate: if RR 60 with 1:2 = 0.3 RR 20 1:3 = 0.7
TV 8ml/kg
HFOV is used to recruit alveoli
As alveoli are recruited the lung becomes more compliant and it is necessary to wean the pressure
Provide oxygen
LFNP
HM
HM with rebreather
Non-Invasive Ventilation
Mouth-to-mask OR
Bag-valve-mask
- 4th and 5th finger Jaw thrust with thumbs holding mask on face (mask upside down for infants)
- Attach O2 if port available
- 20 breaths/min if not CPR
- 2:15 if CPR
CPAP: Continuous positive airway pressure
BiPAP: Bilevel pos airway pressure (CPAP with pressure support)
NPV: Negative Pressure Ventilation (iron lung)
(if difficulty ? airway problem e.g. foreign body ?circuit problem
Invasive ventilation
via ET (N/O), Tracheostomy, needlecric... see airway
Volume limited/Pressure limited
- CMV
- AC
- IMV
- SIMV
Adjusting ventilator settings
Problems
Oxygenation (↓O2): ↑FiO2, ↑MAP (↑PIP or ↑PEEP or ↑Ins time i.e. I:E) if chest hypoexpanded PEEP may be best
Ventilation (↑CO2): ↑minute volume through ↑RR OR ↑TV (↑PIP or ↓PEEP).
If reducing things ?PIP/FiO2 first to reduce barotrauma/oxygen free radicals
Initial settings
PIP 18
PEEP 5
Rate: neonate 25, infant/child 20, adolescent 15
FiO2 start at 1.0 the quick wean to 0.6 and titrate from there
I:E 1:2 (need longer in asthma to allow expiration, then shorter / reversed in hypoxia
(I time will depend on rate: if RR 60 with 1:2 = 0.3 RR 20 1:3 = 0.7
TV 8ml/kg
HFOV is used to recruit alveoli
As alveoli are recruited the lung becomes more compliant and it is necessary to wean the pressure