Initiation of Mechanical Ventilation

Question 1

Indications for Mechanical Ventilation

Answer 1

The indications for mechanical ventilation are (ASIA)

1. Apnea
2. Severe Refractory Hypoxemia
3. Impending Ventilatory Failure
4. Acute Ventilatory Failure

Question 2

Impending Ventilatory Failure Adult Assessment

Answer 2

Vital Signs

Ventilatory pattern

Paradoxical breathing

Retractions

Progressive muscle weakness

Serial blood gases trending worse

Question 3

Impending Ventilatory Failure Neonatal Assessment

Answer 3

Vital Signs

Oxygen requirements

Cyanosis

Retractions

Nasal Flaring

Grunting

ACoRN

Question 4

VD/Vt

Answer 4

Normal: 0.25-0.4

Critical >0.6

Question 5

RR (bpm)

Answer 5

Normal: 12-20

Critical >35

Question 6

Vt (ml/kg)

Answer 6

Normal: 4-8

Critical <4

Question 7

VC (ml/kg)

Answer 7

Normal: 65-75

Critical <10

Question 8

MIP

Answer 8

Normal: -80 to -100

Critical 0 to -20

Question 9

Absolute Contraindications

Answer 9

No absolute contradictions to ventilatory support exist if the above indications are present, but… Are you planning to use Invasive or non-invasive support

Question 10

Normal Lungs

Neo Circuit

Answer 10

Infant circuit with active humidity

Question 11

Normal Lungs

Ped Circuit

Answer 11

>25 kg uses adult/passive (unless indications for active)

<25 kg use infant circuit with active humidity

Question 12

Normal Lungs

Adult Circuit

Answer 12

Adult circuit with passive humidity (unless indication for active)

Question 13

Normal Lungs

PEEP

Answer 13

Match to the FiO2 (once it is weaned to required level); consider optimal PEEP/open lung ventilation

Watch for CV compromise

Question 14

Normal Lungs

Neo PEEP

Answer 14

6 cmH2O

Question 15

Normal Lungs

Ped PEEP

Answer 15

5 cmH2O

Question 16

Normal Lungs

Adult PEEP

Answer 16

5 cmH2O

Question 17

Normal Lungs

Ti

Answer 17

Adjust for pressure equilibrium

Note I:E

Question 18

Normal Lungs

Neo Ti

Answer 18

0.3-0.4 sec

Question 19

Normal Lungs

Teen Ti

Answer 19

0.8-1 sec

Question 20

Normal Lungs

Child Ti

Answer 20

0.7-0.8 sec

Question 21

Normal Lungs

Pre-School Ti

Answer 21

0.6-0.8 sec

Question 22

Normal Lungs

Toddler Ti

Answer 22

0.5-0.75 sec

Question 23

Normal Lungs

Infant Ti

Answer 23

Infant 0.35-0.55 sec

Question 24

Normal Lungs

Adult Ti

Answer 24

0.8-1.2 sec

Question 25

Normal Lungs Adult MV

Answer 25

~100 mL/min/kg Initially adjusted based on PaCO2 MV may be higher if the pt is febrile

Question 26

Normal Lungs RR

Answer 26

Assess ofr auto triggering and auto PEEP

Question 27

Normal Lungs RR

Answer 27

Assess ofr auto triggering and auto PEEP

Question 28

Normal Lungs Neo RR

Answer 28

40-50 bpm

Question 29

Normal Lungs Ped RR

Answer 29

Infant 30-50 bpm Toddler 24-40 bpm Pre-School 20-35 bpm Child 18-30 bpm Teen 12-20

Question 30

Normal Lungs Adult RR

Answer 30

12-16 bpm

Question 31

Normal Lungs Vt

Answer 31

Want a plateu pressure \<30 cmH2O

Question 32

Normal Lungs Neo Vt

Answer 32

5 ml/kg

Question 33

Normal Lungs Ped Vt

Answer 33

6-8 ml/kg

Question 34

Normal Lungs Adult Vt

Answer 34

6-8 ml/kg