Page 591 - Clinical Application of Mechanical Ventilation

Neonatal Mechanical Ventilation 557

TABLE 17-6 Initial Settings for Neonatal Mechanical Ventilation Based on Compliance

Parameter Normal Compliance Low Compliance

PIP 15 to 20 cm H O 20 to 30 cm H O
2
2
PEEP 3 to 5 cm H O Up to 8 cm H O
2
2
V * 4 to 8 mL/kg 6 to 10 mL/kg
T
Frequency 25 to 40/min Up to 150/min (esp. with air leak)

Flow Rate 6 to 8 L/min 6 to 8 L/min
I Time 0.3 to 0.5 sec Change according to frequency to maintain an
I:E ratio of 1:1
I:E Ratio 1:1.5 to 1:2 At least 1:1 (to prevent inverse I:E ratio)

F O 2 Set to keep patient pink with Set to keep patient pink with SpO from 90%
2
I
SpO from 90% to 95% to 95%
2
Use with appropriate PEEP level if necessary
*On ventilators that are capable of providing a preset tidal volume (volume-controlled ventilation). (Data from Bandy et al., 1992; Goldsmith
et al., 1993; Deakins et al., 2001; Walsh et al., 2010.)
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The frequency on many neonatal ventilators is controlled by adjusting the expira-
tory time after setting the flow and inspiratory time. Generally the frequency is
set from 40 to 60/min for premature infants and 25 to 40/min for term infants
(Table 17-7). The frequency is dependent on the ventilatory requirement and dis-
ease process. The inspiratory time is usually set at 0.3 to 0.5 sec, depending on
gestational age, with a shorter inspiratory time when the frequency is high or in the
presence of air trapping. Using the neonate’s body weight as a guide, 5 mL/kg is the
suggested initial tidal volume with a range of 3–7 mL/kg. The PEEP is set between
4 and 8 cm H O depending on the oxygenation status of the infant. A higher PEEP
2
is used initially if the infant’s F O requirement is high, if there is evidence of severe
I
2

TABLE 17-7 Initial Settings for Neonatal Mechanical Ventilation Based on Weight

Parameter Very Low Birth Weight Low Birth Weight Term

Frequency 40 to 60/min 40 to 60/min 25 to 40/min
Inspiratory time 0.3 to 0.5 sec 0.3 to 0.5 sec 0.3 to 0.5 sec

Volume 3 to 7 mL/kg starting at 3 to 7 mL/kg starting 3 to 7 mL/kg starting at
5 mL/kg at 5 mL/kg 5 mL/kg
PEEP 4 to 8 cm H O 4 to 8 cm H O 4 to 8 cm H O
2
2
2
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