Basics of Neonatal Mechanical Ventilation

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What are the 3 objectives for Neonatal Mechanical Ventilation?

1. Support oxygen delivery, CO2 elimination
2. Prevent added injury, decrease ongoing injury
3. Enhance normal development

In what 4 ways would you support oxygen delivery and CO2 elimination?

1. O2 via an oxyhood
2. O2 via cannula (regular / heated / high flow)
3. CPAP (bubble)
4. Intubation, ventilation

What are the 5 ways you would prevent added injury?

1. Minimize invasive therapy
2. Optimize lung volume
3. Target CO2, O2
4. Use appropriate equipment / devices for least risk (aka don't tube unless you have to)
5. Manage fluids and nutrition

In what 3 ways would you try to enhance normal development?

1. Manage fluids and nutrition
2. Encourage patient-driven support
3. Maintain pulmonary toilet - carefully

How would you maintain adequate lung volume?

1. Inspiration: Tidal Volume
2. Expiration: End-expiratory lung volume (Just like PEEP)

How would you support oxygenation and CO2 removal?

Oxygenation: Adequate mean airway pressure
CO2 removal: Adequate minute ventilation

How would you optimize lung mechanical function?

1. Compliance & Resistance
2. Time Constant: C x R

What is a time trigger mechanism?

It is controlled mechanical ventilation - there is NO patient interaction.

What is a pressure trigger mechanism?

The ventilator senses a drop in pressure with patient effort.

What is a flow trigger mechanism?

The ventilator senses a drop in flow with patient effort.

What is a chest impedance / abdominal movement trigger mechanism?

The ventilator senses respiratory/diaphragm or abdominal muscle movement.

What is a diaphragmatic activity trigger mechanism?

NAVA = Neurally adjusted ventilatory assist - Probe is inserted down esophagus and when it senses any electrical activity going toward diaphragm, it triggers a breath (the patient just has to think about giving a breath and one is delivered)

On what type of modes are time cycles used?

On all ventilators

On what type of modes are flow cycles used?

Pressure support mode

What type of modes are volume cycles used?

Adult / pediatric ventilators

What does the CPAP mode offer?

It has +/- pressure support

What does the IMV/SIMV mode offer?

+/- pressure support, volume targeting

What does assist control (pressure) offer?

It has +/- volume targeting. It is a pressure breath with a volume target. The machine wants to give a patient a certain TV so the pressures will either increase or decrease to give that tidal volume

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