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Setting up ventilator on neonate

Guidelines for setting up a Neonatal Ventilator:

1. Patient range: Set to neonate (Maximum VT = 40cc)

2. Mode: Pressure Control (works best for un-cuffed ETT)

3. Tidal Volume (VT)*:

y less than33 weeks gestation 4 6 cc/kgy greater than33 weeks gestation or chronic 5 7 cc/kg

4. Peak Inspiratory Pressure (PIP)*:

y less than27 weeks gestation set at 24 CWPy 27 32 weeks gestation set at 26 CWPy 33 40 weeks gestation set at 28 CWPy Start low (best to err on low side to prevent barotraumas.)y Increase to obtain target VT and adequate chest risey Frequently monitor & adjust PIP to accommodate changes in lung compliance

altering tidal volume.

5. Positive End Expiratory pressure (PEEP):

y Start at minimum 4 5 CWPy Increase to 6 7 CWP ifFiO2 needs greater than 60%y Adjust to maintain acceptable PaO2 and SpO2y 8 10 CWP PEEP if directed by physiciany Remember that Pressure Control (PC) setting is above PEEP

6. Fraction of Inspired Oxygen (FiO2)**:

y Start low at 40%y Adjust to maintain target SpO2y If SaO2 less than target range, FiO2 may be increased by 25, & then allowing 4

minutes for stabilization after each change. (consider adjustment of PIP and PEEPalso.)

yContinue assuring

AW patent, H

Rgreater than100 & baby not apneic.

y If SaO2 greater than target range, FiO2 may be decreased by 2 5,allowing 4 minutes for stabilization after each change.

y Consider increasing PEEP prior to FiO2y Maintain neonate on ROOM AIRwhenever possible.

7. Rate:

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y 50 60 if less than 34 weeks gestation or less than 3 kgy 40 50 if greater than 34 weeks gestation or greater than 3 kgy 30 40 if 40 weeks gestation; slightly higher if indicated.y Watch for air trapping at rates greater than 40 (adjust I-time).

8. I-time:

y Start at 0.3 plus or minus 0.5 (post-term may need more.)y Neonatal initial I-time settingy less than 1kg 0.25 0.30 sec minimum 0.20 secondsy 1-2kg 0.30 0.40 sec minimum 0.20 secondsy 2-3kg 0.35 0.45 sec minimum 0.25 secondsy 3-4kg 0.40 0.60 sec minimum 0.30 secondsy Ideally set using Flow-time graphicsy This alters I-time and I:E ratioy Increase & decrease to reach target settings as appropriatey

Watch for air trapping at rates greater than 40 in neonates greater than 3kg; theymay need I-time greater than 0.40 to complete inspiration & prevent air trapping.

y If neonate using expiratory muscles, try decreasing I-timeslightly (increasing flow).

y If I-time gets too short, consider switch to PRVC.9. I-Rise time:

y 10 if less than 33 weeks gestational agey greater than 5 if greater than 33 weeks gestational agey Basically, the smaller the ETT the higher this should be to

create laminar flow and a pseudo sign wave.y Increase for bronchospasm (slow rise time, longer e-time)

10. PIP limit: 2 3 greater than PIP (all other alarms as appropriate.)

*Note: Higher PIP and VT may be needed in certain cases. Consult physician if unable toventilate at recommended settings. Settings may also be unique to particular ventilator,

guidelines, or protocol.

**Note #2: New studies show that high levels of oxygen, even in term babies and evenfor periods of less than a minute, can result in long term consequences to the child such

as Retnopathy of Prematurity. Proper ranges to strive for will be the topic of a future post.

Note #3: The above information may be slightly different for your institution and theequipment available, yet the principle remains the same regardless of where you work.