mechanical ventilation
in Neonates
Dr Mohd Maghayreh
PRTH -IRBID
Introduction
Mechanical ventilation is an invasive life-
support procedure with many effects on
the cardiopulmonary system.
The goal is to optimize both gas
exchange and clinical status at minimum
FiO2 and ventilator pressure. The
ventilator strategy employed to
accomplish this goal depends in part on
the infant’s disease process.
Introductio n
Resistance (cmH2O/L/sec) =
Change in pressure (cmH2O)
Change in flow (L/sec)
RDS ↓ ↓ ↓ ↓ ↓ ↑
MAS ↓ ↑ ↑ ↑ ↓ ↑
Lung Mechanics in
).Dise ase St ates ) cont
Diseas Complianc Resistance Time FRC V/Q W
e e cm/H20/ml/ Consta ml/k matchi ork
ml/cmH2O s nt g ng
sec
BPD ↑/ ↓ ↑ ↑ ↑ ↓ ↑
Air ↓ ↑ ↑ ↑ ↓ ↑
leak
VLBW ↓ ↓ ↓ ↓ ↓ ↑
apnea
Gas Ex change during
Assist ed Ve ntil atio n
Carbon dioxide (CO2)
Diffuses rapidly from the blood into the alveoli.
Its elimination depends largely on the total
amount of gas that goes through the alveoli =
alveolar ventilation.
Alveolar ventilation per minute is calculated as:
Minute alveolar ventilation= (Tidal volume –
Dead space) X Frequency
Gas Ex change during
Assist ed Ve ntil atio n
).) cont
Tidal volume (for a given compliance) is
determined by the pressure gradient
between inspiration and expiration, i.e.
peak inspiratory pressure (PIP) minus
positive end expiratory pressure (PEEP).
Gas Ex change during
Assist ed Ve ntil atio n
).) cont
Inspiratory duration may partially determine the
tidal volume; very short inspiratory time may
not allow pressure to be equilibrated
throughout the respiratory system in infants
with normal lungs and with relatively long time
constants, resulting in decreased tidal volume.
So tidal volume can be decreased by
shortening the inspiratory time.
Inspiratory flow.
PIP.
Ratio of Ti to Te (I/E ratio).
PEEP.
Frequency (or rate) by shortening Te.
Gas Ex change during
Assist ed Ve ntil atio n
).) cont
Special notes (cont.)
Very high Paw may cause over-distention of airways
and alveoli, leading to an increase in dead space and
right-to-left shunting of blood in the lungs.
Fio2 As indicated
Systemic flow 8-10l/min
Rate 60 breaths / min
Ti/Te 1:1.25 - 1:4
PIP 18 - 22cm H20
Good breath sounds
PEEP 3 - 5cm H20
Su bsequent Se ttin gs o f
Me chanic al Ve ntila tio n
Measure arterial blood gases half an
hour after the initial setting and adjust the
setting accordingly. (Table)