View source for Initial mechanical ventilation settings (peds)

{{Peds top}} [[initial mechanical ventilation settings]].''
==Background==
*In the neonate, volume-targeted ventilation mode has been shown to have improved outcomes over pressure-limited ventilation<ref>Wheeler K, Klingenberg C, McCallion N, Morley CJ, Davis PG. Volume-targeted versus pressure-limited ventilation in the neonate. Cochrane Database Syst Rev 2010;11:CD003666.</ref>
**Must use cuffed tube for volume-targeted ventilation

{{Peds Resp Rates}}

==Non-Pulmonary Problem (e.g. trauma)==
''As a general rule, a traditional strategy is appropriate for most patients (similar to adults)<ref>Kneyber et.al. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med. 2017 Dec;43(12):1764-178.</ref>''
*FiO2: 100% (1.0) and ween down 
*Rate: See normal respiratory rates by age above
*Mode: [[Ventilation_modes#Modes|Volume assist control (AC)]]
**A/C = default (most) 
*PEEP: 5 cmH20 
*Tidal volume: 8 cc/kg
**(adjust to plateau pressure <35 cmH20)

==Lung Protective Strategy==
===Background===
*Focuses on low-tidal volume ventilation to reduce ventilator-associated lung injury (e.g. barotrauma and volutrauma worsening/causing [[ARDS]])<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref>
*Indicated for all intubated patients who do not have obstructive lung disease ([[COPD]], [[asthma]])<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref>

{{Lung Protective Ventilator Settings Peds}}
{{Lung Protective FiO2 and PEEP Scale}}

==Obstruction Strategy==
===Background===
*For patients with active bronchoconstriction (e.g. [[COPD]], [[asthma]])
*The best ventilatory strategy for these patients is to avoid intubation if possible; mechanical ventilation will often make the pulmonary situation worse, rather than better.<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref>
*Goal = adequate time for expiration
*Frequently requires deep sedation and analgesia (first-line); may required paralysis (second-line)<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref>

===Settings===
#Mode
#*Volume-assist control
#Tidal Volume
#*Vt = 6-8 cc/kg of Ideal Body Weight
#**Ideal Body Weight used because lung parenchyma does not increase in size as the person gains more weight
#Inspiratory Flow Rate
#*60-80 L/minute
#**Some advocate for higher rates (e.g. 80-100 LPM) to allow more expiration time, however this will increase the peak pressures and has not shown to produce any clinically meaningful change in the expiration time<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref><ref>Leatherman JW, McArthur C, Shapiro RS. Effect of prolongation of expiratory time on dynamic hyperinflation in mechanically ventilated patients with severe asthma. Crit Care Med. 2004;32:1542-1545.</ref>
#FiO2/PEEP
#*Titrate FiO2 to desired SpO2
#*Set PEEP 0-5
#Respiratory Rate
#*Set low - 10 BPM
#*Adjust for I:E 1:4 or 1:5
#*Permissive hypercapnia to avoid breath stacking
#**Ok as long as pH > 7.00-7.10
#**Maintain plateau pressure <30<ref>20. Oddo M, Feihl F, Schaller MD, Perret C. Management of mechanical ventilation in acute severe asthma: practical aspects. Intensive Care Med. 2006; 32(4):501-510.</ref>
#***If >30 go down on rate

==Hypovolemic==
*Consider reducing PEEP to maintain adequate preload and prevent/minimize hypotension

==Miscellaneous==
''Normally already set''
*Inspiratory flow rate = 60L/min<ref>Weingart SD. Managing Initial Mechanical Ventilation in the Emergency Department. Ann Emerg Med. 2016;68:614-617</ref> (100 L/min with asthma) 
*Sensitivity = 1-2 cmH2O

==See Also==
{{Pediatric critical care pages}}
{{Mechanical ventilation pages}}

==External Links==
*[http://www.emdocs.net/pediatric-mechanical-ventilation-in-the-emergency-department-taking-away-the-big-anxiety-over-small-lungs/ EMdocs Pediatric Mechanical Ventilation]

==References==
<references/>

[[Category:Critical Care]] 
[[Category:Pulmonary]]
[[Category:Pediatrics]]