Neonatal Mechanical Ventilation

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Neonatal Mechanical Ventilation
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Pressure Ventilation

• Time cycled
• Pressure limited
• Continuous flow
• Two modes
• CPAP
• IMV

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CPAP
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IMV
Press
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CPAP
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Two Methods of Pressure Ventilation

• Pressure limited
• Not pressure limited

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Ventilator Settings for Both Methods

• Inspiratory Time
• Rate / Exp Time
• Flowrate
• FIO2 on Blender

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Pressure Limited Ventilation

• PIP Limit reached during inspiration
• Does not end inspiration

PRESS
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Tidal Volume Depends On

• Pressure Limit level
• Flowrate
• Inspiratory Time
• Compliance
• Resistance
• Leak around uncuffed ET

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FLOW
Alveolar Pressure
PRESS
Pressure Limited
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FLOW
Alveolar Pressure
PRESS
Pressure Limited
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To Increase Tidal Volume

• Increase Pressure Limit
• Want Pressure Limit lt 30 cm H20

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When Increasing Pressure Limit Does Not Increase
PIP

• Increase Flowrate
• Increase Inspiratory Time

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When Pressure Limiting Ventilation

• Increasing PEEP Decreases Tidal Volume

F
P
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For Ventilation Not Limited by PIP Limit

• Usually calculate desired tidal volume
• Deliver double calculated volume
• Estimate lose half around tube

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FLOW
Pressure Limit
PRESS
Not Pressure Limited
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Your Lab Assignment

• Will PEEP Decrease VT if ventilation is not
  pressure limited?

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A Few Differences between Adult and Neonatal
Ventilation

• Tidal Volumes Are Usually Not Measured in
  Neonatal Ventilation
• Neonatal Ventilator Alarms May Not Detect
  Obstructed Endotracheal Tubes
• Ventilator changes are in smaller increments in
  neonatal ventilation

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For Ex. PEEP Levels

• Low 1 - 3 cm H20
• Medium 4 - 7 cm H20
• High 8 - 10 cm H20

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PIP Limit Changes

• 2 - 3 cm H20

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FIO2 Changes

• 1-2

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Summary

• Time cycled - reaching PIP limit does not end
  inspiration.
• Ventilation may be pressure limited or not.
• Make small changes in vent settings.
• Suction to check ETT patency.
• No cuff on ETT tube.

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Heated Wire Circuit

• Purpose is to prevent excessive rainout in
  circuit.
• Two temperature probes
• Patient (proximal)
• Humidifier
• Two heated wire connections
• Inspiratory limb
• Expiratory limb

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Lo Temp Alarm 27o C
Hi Temp Alarm 40o C
DISABLE
TEMP
LO TEMP
ALARM
TEMP C
ENABLE
RESET
ON
TEMP SET
OFF
HEATER FUNCTION
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Relative Humidity Important with heated wire
circuits

• Mucus plugging may occur if heated wire
  temperature higher than humidifier temperature.
• Check relative humidity by the presence of beads
  of moisture at the patient wye.

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