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
What is a time trigger mechanism?
It is controlled mechanical ventilation - there is NO patient interaction.
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)