Neonatal Mechanical Ventilation
Neonates have:
- Higher airway resistance
- Lower lung compliance
- Less surface area for gas exchange
Neonate: any infant younger than 44weeks gestation
PEDI: child older than 1 month of age
Conventional MV: provides 150 bpm or less
- Related directly to an increase in MAP
- Flow rate
- Ti
- Peep
HFV: provides more than 150 bpm. HFV uses smaller pressures and higher frequencies. Frequency is set
at 10Hz and amplitude is adjusted to see wiggle present. Increase every 30 min by 4-6 units. HFV
promotes better alveolar growth and development in preterm lungs. 1Hz= 60 bpm
Indications:
- Heterogenous lung disease (RDS/ARDS) if Paw exceeds 15cmH2O
- PNA
- PPHN
- PIE
- PNX
- Pulm hypoplasia
HFOV: inspiration and expiration are active, bulk flow rather than just jet pulsations, Vt is less than dead
space.
HFJV: delivered through a triple lumen ET. Delivery of short jet breaths or pulsations of O2 and air under
considerable amounts of pressure through an ETT. Vt depends on the length of the pulsation, the
amplitude or the driving pressure of the jet, the size of the orifice, and the Raw and compliance. Vt of 1-
3mL.
Goals of MV: SAFETY, COMFORT, LIBERATION
HFJV- short, pulsed jets of gas into the airway
HFOV- small tidal volumes and very high rates of 3-15Hz
Volume Control- Set/control tidal volume. Set RR, PEEP fio2. Known Mve
A decrease in compliance is going to cause an increase in peak pressures
Pressure Control- preset PIP for a desired VT to prevent overdistention. Set RR, PIP, Ti, PEEP, fio2
PRVC- RR, VT, Ti, Pmax, PEEP, fio2
SIMV- RR, VT, PEEP, FIO2
PS- PS, PEEP, FIO2
, APRV- T high, T low, P high, P low, fio2
Ventilatory failure in neo:
-PaO2 less than 60
- pH less than 7.24
Oxygenation failure:
- PaO2 less than 50 on 80-100% oxygen or SaO2 less than 88% with fio2 80-100
Oxygen ther apy -> HHFNC -> NCPAP -> NNPV ->InSURE
NIV:
Improves PaO2
Improves lung mechanics
Stabilizes chest wall
Improves VQ ratio
Increases FRC which improves compliance
CPAP decreases pulmonary shunting
Restores FRC and reduces WOB
Indications for NIV:
- Increased WOB
- Retractions
- Grunting/Nasal flaring
- Cyanosis
- PaO2 less than 50mmHg/ pH of 7.25 or higher
- Obstructive/restrictive lung diseases
- PN
- TTN
- MAS
- CHF/Pulm. Edema/Pulm Hemorrhage
- Post OP for Diaphragmatic hernia
- RSV
Contraindications:
- PaCO2> 60mmHg
- pH< 7.25
- upper airway abnormalities
- neuromuscular disorders
- CNS depressant meds
- Apnea
- Nasal obstruction
- Upper airway malformation
- Choanal atresia/cleft palate/tracheoesophageal fistula
Physical Assessment- retractions, grunting, nasal flaring.
Neonates have:
- Higher airway resistance
- Lower lung compliance
- Less surface area for gas exchange
Neonate: any infant younger than 44weeks gestation
PEDI: child older than 1 month of age
Conventional MV: provides 150 bpm or less
- Related directly to an increase in MAP
- Flow rate
- Ti
- Peep
HFV: provides more than 150 bpm. HFV uses smaller pressures and higher frequencies. Frequency is set
at 10Hz and amplitude is adjusted to see wiggle present. Increase every 30 min by 4-6 units. HFV
promotes better alveolar growth and development in preterm lungs. 1Hz= 60 bpm
Indications:
- Heterogenous lung disease (RDS/ARDS) if Paw exceeds 15cmH2O
- PNA
- PPHN
- PIE
- PNX
- Pulm hypoplasia
HFOV: inspiration and expiration are active, bulk flow rather than just jet pulsations, Vt is less than dead
space.
HFJV: delivered through a triple lumen ET. Delivery of short jet breaths or pulsations of O2 and air under
considerable amounts of pressure through an ETT. Vt depends on the length of the pulsation, the
amplitude or the driving pressure of the jet, the size of the orifice, and the Raw and compliance. Vt of 1-
3mL.
Goals of MV: SAFETY, COMFORT, LIBERATION
HFJV- short, pulsed jets of gas into the airway
HFOV- small tidal volumes and very high rates of 3-15Hz
Volume Control- Set/control tidal volume. Set RR, PEEP fio2. Known Mve
A decrease in compliance is going to cause an increase in peak pressures
Pressure Control- preset PIP for a desired VT to prevent overdistention. Set RR, PIP, Ti, PEEP, fio2
PRVC- RR, VT, Ti, Pmax, PEEP, fio2
SIMV- RR, VT, PEEP, FIO2
PS- PS, PEEP, FIO2
, APRV- T high, T low, P high, P low, fio2
Ventilatory failure in neo:
-PaO2 less than 60
- pH less than 7.24
Oxygenation failure:
- PaO2 less than 50 on 80-100% oxygen or SaO2 less than 88% with fio2 80-100
Oxygen ther apy -> HHFNC -> NCPAP -> NNPV ->InSURE
NIV:
Improves PaO2
Improves lung mechanics
Stabilizes chest wall
Improves VQ ratio
Increases FRC which improves compliance
CPAP decreases pulmonary shunting
Restores FRC and reduces WOB
Indications for NIV:
- Increased WOB
- Retractions
- Grunting/Nasal flaring
- Cyanosis
- PaO2 less than 50mmHg/ pH of 7.25 or higher
- Obstructive/restrictive lung diseases
- PN
- TTN
- MAS
- CHF/Pulm. Edema/Pulm Hemorrhage
- Post OP for Diaphragmatic hernia
- RSV
Contraindications:
- PaCO2> 60mmHg
- pH< 7.25
- upper airway abnormalities
- neuromuscular disorders
- CNS depressant meds
- Apnea
- Nasal obstruction
- Upper airway malformation
- Choanal atresia/cleft palate/tracheoesophageal fistula
Physical Assessment- retractions, grunting, nasal flaring.
