Ventilator setting

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Ventilator setting

  1. 1. The name of GodCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  2. 2. Mechanical Ventilation Ventilator SettingCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  3. 3. Mechanical Ventilation Non Invasive Invasive Non Invasive: Ventilatory support that is given without establishing endo- tracheal intubation or tracheostomy is called Non invasive mechanical ventilation Invasive: Ventilatory support that is given through endo- tracheal intubation or tracheostomy is called as Invasive mechanical ventilationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  4. 4. Non invasive Negative pressure Positive pressure Producing Neg. pressure Delivering air/gas with intermittently in the pleural positive pressure to the space/ around the thoracic cage airway e.g.: Iron Lung BiPAP & CPAPCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  5. 5. Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  6. 6. Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  7. 7. Invasive Positive Pressure Pressure Volume Time cycle cycle cycle Pressure Cycle:A pre determined and preset pressure terminates inspiration. Pressure is constant and volume is variable. Volume Cycle:A pre determined and preset volume - on completion of its delivery , terminates the inspiratio. Pressure is variable and volume is constant.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  8. 8. Ventilator Settings Terminology •A/C: Assist-Control •IMV: Intermittent Mandatory Ventilation •SIMV: Synchronized Intermittent Mandatory Ventilation •Bi-level/Biphasic: Non-inversed Pressure Ventilation with Pressure Support (consists of 2 levels of pressure)Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  9. 9. Ventilator Settings Terminology (con’t) •PRVC: Pressure Regulated Volume Control •PEEP: Positive End Expiratory Pressure •CPAP: Continuous Positive Airway Pressure •PSV: Pressure Support Ventilation •NIPPV: Non-Invasive Positive Pressure VentilationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  10. 10. Noninvasive Bilateral Positive Airway Pressure Ventilation (BiPAP) • BiPAP is a noninvasive form of mechanical ventilation provided by means of a nasal mask or nasal prongs, or a full-face mask. • The system allows the clinician to select two levels of positive-pressure support: • An inspiratory pressure support level (referred to as IPAP) • An expiratory pressure called EPAP (PEEP/CPAP level).Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  11. 11. ‫)‪(Adaptive Support Ventilation‬‬ ‫‪ASV‬‬ ‫• اﯾﻦ ﻣﺪ ھﻮﺷﻤﻨﺪ ﺗﻨﻔﺴﯽ ﺑﯿﻤﺎران را از وﺿﻌﯿﺖ ﮐﺎﻣ ً ﻏﯿﺮ ﻓﻌﺎل ﺗﺎ ﮐﺎﻣ ً ﻓﻌﺎل‬ ‫ﻼ‬ ‫ﻼ‬ ‫ﺑﺼﻮرت ﺗﻄﺒﯿﻖ ﭘﺬﯾﺮ وﻧﺘﯿﻠﮫ ﻣﯿﮑﻨﺪ.وزن ﺑﯿﻤﺎر ﮐﮫ ﻣﺒﯿﻦ ﺣﺠﻢ دﻗﯿﻘﮫ ای ﻣﯽ‬ ‫ﺑﺎﺷﺪ ﺑﮫ ﻋﻨﻮان ﭘﺎراﻣﺘﺮ ورودی ﺑﮫ دﺳﺘﮕﺎه داده ﻣﯿﺸﻮد و دﺳﺘﮕﺎه ﺑﺎ ﺳﻨﺠﺶ‬ ‫وﺿﻌﯿﺖ ﺗﻨﻔﺴﯽ ﺑﯿﻤﺎر و ﭘﺮدازش اﻃﻼﻋﺎت ‪Respiratory Rate‬و ‪Tidal‬‬ ‫‪ volume‬را ﺑﺼﻮرت اﺗﻮﻣﺎﺗﯿﮏ و ﭘﯿﻮﺳﺘﮫ ﺗﻨﻈﯿﻢ ﻣﯽ ﻧﻤﺎﯾﺪ.‬ ‫• در اﯾﻦ ﻣﺪ ﻣﻘﺎدﯾﺮ ‪ Peep‬و 2‪ Fio‬ﺑﺎ ﺗﻮﺟﮫ ﺑﮫ ﻣﯿﺰان اﮐﺴﯿﮋﻧﺎﺳﯿﻮن ﺑﯿﻤﺎر‬ ‫ﺗﻮﺳﻂ اﭘﺮاﺗﻮر ﺗﻨﻈﯿﻢ ﻣﯿﮕﺮدﻧﺪ.‬ ‫• از آﻧﺠﺎ ﮐﮫ ﻣﺪ ‪ ASV‬ﻋﻤﻞ وﻧﺘﯿﻼﺳﯿﻮن ﺑﯿﻤﺎر را ﺑﺼﻮرت ﺧﻮدﮐﺎر اﻧﺠﺎم‬ ‫ﻣﯽ دھﺪ در ﻧﺘﯿﺠﮫ ﻧﯿﺎز زﯾﺎدی ﺑﮫ اﻧﺠﺎم ﻋﻤﻠﯿﺎت ﺗﻮﺳﻂ اﭘﺮاﺗﻮر ﻧﻤﯽ ﺑﺎﺷﺪ‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  12. 12. ‫‪Airway Pressure Release‬‬ ‫)‪Ventilation(APRV‬‬ ‫• دو ﺳﻄﺢ ﻣﺘﻔﺎوت از ‪) CPAP‬دم وﺑﺎزدم(ﺗﻨﻈﯿﻢ ﻣﯽ ﺷﻮﻧﺪ ﺑﺮای‬ ‫دوره ھﺎﯾﯽ از زﻣﺎن ، ﮐﮫ اﺟﺎزه ﻣﯽ دھﻨﺪ ﺗﻨﻔﺲ ھﺎی ﺧﻮد ﺑﺨﻮد‬ ‫در اﯾﻦ دو ﺳﻄﺢ اﺗﻔﺎق ﺑﯿﻔﺘﺪ.‬ ‫• ‪ APRV‬ﺗﻨﻔﺲ ﺧﻮد ﺑﺨﻮد اﺳﺖ و ﻣﺪی اﺳﺖ ﮐﮫ ﺑﺮای ﺑﺎز ﻧﮕﮫ‬ ‫داﺷﺘﻦ آﻟﻮﺋﻮﻟﮭﺎ ﺑﮫ ﮐﺎر ﻣﯽ رود ﺑﺪون آﻧﮑﮫ ﻓﺸﺎر ‪ PIP‬اﻓﺰاﯾﺶ‬ ‫ﯾﺎﺑﺪ.ﭼﻮن اﻓﺰاﯾﺶ ﻓﺸﺎر ﻣﻨﺠﺮ ﺑﮫ ﺑﺎروﺗﺮوﻣﺎ ﻣﯽ ﺷﻮد.‬ ‫‪P high=PSV‬‬ ‫‪P low=PEEP‬‬ ‫• در اﯾﻦ اﻟﮕﻮ ﺑﯿﻤﺎر ﺑﺎﯾﺴﺘﯽ از ﻧﻈﺮ ھﯿﭙﺮ ﮐﺎﭘﻨﯽ ﻣﺎﻧﯿﺘﻮر ﺷﻮد.‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  13. 13. Ventilator Setting ‫• ﺗﻨﻈﯿﻢ وﻧﺘﯿﻼﺗﻮر‬ – Tidal Volume – Breath Per Minutes (RR) – I:E ratio – Flow Wave Pattern – Fio2 – Sigh – Trigger or Sensitivity • Pressure Trigger • Flow Trigger ( Flow By) – Peak Flow – Peep – Plateau ( Pause) – O2 Flash – NebulizerCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  14. 14. Tidal Volume 6-10cc/kg (IBW) ‫ﺣﺠﻢ ﺟﺎري‬ • 6cc/kg ARDS ‫در‬ • 6-8 cc/kg COPD ‫در‬ • 8-10 cc/kg ‫در ﺑﯿﻤﺎري ﻧﻮروﻣﻮﺳﻜﻮﻟﺮ ﯾﺎ ﭘﺲ از ﻋﻤﻞ ﺟﺮاﺣﻲ‬ • .‫ 53 ﺑﺎﺷﺪ‬cmH2O ‫ﻓﺸﺎر ﭘﻼﺗﻮ ﺑﺎﯾﺴﺘﻲ ﻛﻤﺘﺮ از‬ •Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  15. 15. For adult patients and older children:- With COPD • A reduced tidal volume • A reduced respiratory rate For infants and younger children:- • A small tidal volume • Higher respiratory rateCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  16. 16. ‫)‪Breath Per Minutes (RR‬‬ ‫ﺗﻌﺪاد ﺗﻨﻔﺲ و ﺣﺠﻢ ﺟﺎري ﺗﻌﯿﯿﻦ ﻛﻨﻨﺪه ﺗﮭﻮﯾﮫ دﻗﯿﻘﮫاي ھﺴﺘﻨﺪ.‬ ‫•‬ ‫ﺗﻌﺪاد ﺗﻨﻔﺲ ٢١ ﺗﺎ ٥١ در دﻗﯿﻘﮫ ﺗﻨﻈﯿﻢ ﻣﻲﻛﻨﯿﻢ ﺗﺎ ﺗﮭﻮﯾﮫ دﻗﯿﻘﮫاي 01-7‬ ‫•‬ ‫‪ L/Min‬ﺣﺎﺻﻞ ﺷﻮد. اﮔﺮ ﺣﺠﻢ ﺟﺎري ﭘﺎﺋﯿﻦ و ‪ PH‬ھﻢ ﭘﺎﺋﯿﻦ اﺳﺖ ‪RR‬‬ ‫ﺑﺎﻻﺗﺮي ﻧﯿﺎز اﺳﺖ.‬ ‫ﺗﻌﺪاد ﺗﻨﻔﺲ ﻃﻮري اﻧﺘﺨﺎب ﺷﻮد ﺗﺎ ‪ PH‬و 2‪ PaCO‬ﻣﻨﺎﺳﺐ ﺑﺎﺷﺪ.‬ ‫•‬ ‫ﺗﻌﺪاد ﺗﻨﻔﺲ زﯾﺎد ﻣﻨﺠﺮ ﺑﮫ ‪ Auto-peep‬ﻣﻲﺷﻮد.‬ ‫•‬ ‫ﺗﮭﻮﯾﮫ دﻗﯿﻘﮫاي ﺑﺎﻻ )‪ (>10L/Min‬ﻣﻨﺠﺮ ﺑﮫ ﻓﻀﺎي ﻣﺮده ﻣﻲﺷﻮد.‬ ‫•‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  17. 17. In a patient with head injury, • Respiratory alkalosis may be required to promote cerebral vasoconstriction, with a resultant decrease in ICP. • In this case, the tidal volume and respiratory rate are increased ( hyperventilation) to achieve the desired alkalotic pH by manipulating the PaCO2.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  18. 18. In a patient with COPD • Baseline ABGs reflect an elevated PaCO2 should not hyperventilated. Instead, the goal should be restoration of the baseline PaCO2. • These patients usually have a large carbonic acid load, and lowering their carbon dioxide levels rapidly may result in seizures.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  19. 19. ‫‪I:E ratio‬‬ ‫زﻣﺎن دم ﺑﺎ ‪ VT ،flow‬و اﻟﮕﻮي ﺟﺮﯾﺎن ﺗﻌﯿﯿﻦ ﻣﻲﺷﻮد.‬ ‫•‬ ‫زﻣﺎن ﺑﺎزدم ﺑﺎ زﻣﺎن دم و ﺗﻌﺪاد ﺗﻨﻔﺲ ﺗﻌﯿﯿﻦ ﻣﻲﺷﻮد.‬ ‫•‬ ‫زﻣﺎن ﺑﺎزدم ﺑﺎﯾﺴﺘﻲ ﺑﯿﺸﺘﺮ از زﻣﺎن دم ﺑﺎﺷﺪ.‬ ‫•‬ ‫اﮔﺮ ‪ ) BP‬در ﭘﺎﺳﺦ ﺑﮫ ﺗﮭﻮﯾﮫ ﻣﻜﺎﻧﯿﻜﻲ ﯾﺎ ‪ (Auto-PEEP‬زﻣﺎن‬ ‫•‬ ‫ﺑﺎزدم ﺑﺎﯾﺪ ﻃﻮﻻﻧﻲ ﺷﻮد ) ‪ flow‬ﺑﺎﻻﺗﺮ، ﺣﺠﻢ ﺟﺎري ﭘﺎﺋﯿﻨﺘﺮ، ﺗﻌﺪاد‬ ‫ﺗﻨﻔﺲ ﻛﻤﺘﺮ(‬ ‫زﻣﺎن دم ﻃﻮﻻﻧﻲ، ﻓﺸﺎر ﻣﺘﻮﺳﻂ راه ھﻮاﺋﻲ را اﻓﺰاﯾﺶ داده و ﺳﺒﺐ‬ ‫•‬ ‫ﺑﮭﺘﺮ ﺷﺪن 2‪ PaO‬ﻣﻲﺷﻮد.‬ ‫زﻣﺎن دم ﻃﻮﻻﻧﻲ ﻧﯿﺎز ﺑﮫ ﻣﻮﻧﯿﺘﻮرﯾﻨﮓ ھﻤﻮدﯾﻨﺎﻣﯿﻚ و ‪Auto-PEEP‬‬ ‫•‬ ‫دارد.‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  20. 20. ‫2‪Fio‬‬ ‫• ﺗﮭﻮﯾﮫ ﻣﻜﺎﻧﯿﻜﺎل را ﺑﺎ 1=2‪ Fio‬ﺷﺮوع ﻛﻨﯿﺪ.‬ ‫• ﺑﺎ اﺳﺘﻔﺎده از ﭘﺎﻟﺲ اﻛﺴﻲﻣﺘﺮ ﻣﯿﺰان 2‪ Fio‬را ﻛﺎھﺶ دھﯿﺪ.‬ ‫• ﻧﺎﺗﻮاﻧﻲ در ﻛﺎھﺶ 2‪ Fio‬ﺑﮫ ﻛﻤﺘﺮ از 6.0 ﻧﺸﺎﻧﮫ وﺟﻮد ﺷﻨﺖ‬ ‫اﺳﺖ.‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  21. 21. • In adult patients the initial FiO2 may be set at 100% • until arterial blood gases can document adequate oxygenation. • An FiO2 of 100% for an extended period of time can be dangerous ( oxygen toxicity) but it can protect against hypoxemia • For infants, and especially in premature infants, high levels of FiO2 (>60%) should be avoided. • Usually the FIO2 is adjusted to maintain an SaO2 of greater than 90% (roughly equivalent to a PaO2 >60 mm Hg). • Oxygen toxicity is a concern when an FIO2 of greater than 60% is required for more than 25 hoursCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  22. 22. ‫‪Peep‬‬ ‫اﺳﺘﻔﺎده از ‪ Peep‬اﻛﺴﯿﮋﻧﺎﺳﯿﻮن را اﻓﺰاﯾﺶ ﻣﻲدھﺪ. ﻣﻌﻘﻮل اﺳﺖ ﻛﮫ از ‪peep‬‬ ‫•‬ ‫ﺣﺪاﻗﻞ ٣ ﺗﺎ ٥ ﺳﺎﻧﺘﯿﻤﺘﺮ آب در ﺷﺮوع ﺗﮭﻮﯾﮫ ﻣﻜﺎﻧﯿﻜﻲ اﺳﺘﻔﺎده ﺷﻮد.‬ ‫‪ Peep‬را ﻃﻮري ﺗﻨﻈﯿﻢ ﻛﻨﯿﺪ ﺗﺎ ﺳﻄﺢ ﻣﻮرد ﻧﻈﺮ اﻛﺴﯿﮋﻧﺎﺳﯿﻮن ﺑﺪﺳﺖ آﯾﺪ.‬ ‫•‬ ‫در ﺑﯿﻤﺎران ﺑﺎ ‪ Peep ،COPD‬را ﺟﮭﺖ ﺑﮭﺒﻮد ﺗﻮاﻧﺎﯾﻲ ﺑﯿﻤﺎر در ﺗﺮﯾﮕﺮ ﻛﺮدن‬ ‫•‬ ‫وﯾﻨﯿﻼﺗﻮر ﻣﻲﺗﻮان ﺑﻜﺎر ﺑﺮد.‬ ‫در ﺑﯿﻤﺎران ﺑﺎ ﻧﺎرﺳﺎﺋﻲ ﺑﻄﻦ ﭼﭗ ‪ Peep‬ﻣﻲ ﺗﻮاﻧﺪ ﺑﺎ ﻛﺎھﺶ ﺑﺎزﮔﺸﺖ ورﯾﺪي‬ ‫•‬ ‫و اﻓﺘﺮﻟﻮد ﺑﻄﻦ ﭼﭗ ﻋﻤﻠﻜﺮد ﻗﻠﺒﻲ را ﺑﮭﺒﻮد ﺑﺨﺸﺪ.‬ ‫در ﺳﻄﻮح ﺑﺎﻻي ‪ Peep‬ﺣﺠﻢ ﺟﺎري را ﻛﺎھﺶ دھﯿﺪ.‬ ‫•‬ ‫‪ Peep‬در ﺑﯿﻤﺎري رﯾﻮي ﯾﻜﻄﺮﻓﮫ اﻛﺴﯿﮋﻧﺎﺳﯿﻮن را ﻛﺎھﺶ ﻣﻲ دھﺪ زﯾﺮا ﺳﺒﺐ‬ ‫•‬ ‫ﺷﯿﻔﺖ ﺧﻮن ﺑﮫ رﯾﮫاي ﻛﮫ وﻧﺘﯿﻠﮫ ﻧﻤﻲ ﺷﻮد ﻣﻲﮔﺮدد.‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  23. 23. ‫‪Flow Wave Pattern‬‬ ‫ﻃﺮح ﻣﺮﺑﻌﻲ ) ‪(square‬‬ ‫•‬ ‫ﻃﺮح ﺳﯿﻨﻮﺳﻲ )‪(Sinusoidal‬‬ ‫•‬ ‫ﻃﺮح ﺻﻌﻮدي )‪(Accelerating‬‬ ‫•‬ ‫ﻃﺮح ﻧﺰوﻟﻲ )‪(Decelerating‬‬ ‫•‬ ‫ﺣﺎﻟﺘﮭﺎي ﻣﻮج ‪ flow‬ﺣﺪاﻛﺜﺮ ﻓﺸﺎر راه ھﻮاﺋﻲ )‪ (PIP‬و ﻓﺸﺎر ﻣﺘﻮﺳﻂ راه‬ ‫•‬ ‫ھﻮاﺋﻲ )‪ (Paw‬ﻣﺨﺘﻠﻔﻲ اﯾﺠﺎد ﻣﻲﻛﻨﻨﺪ. در اﻧﺘﺨﺎب ﻧﻮع ‪ flow‬ﺑﺎﯾﺪ در ﻧﻈﺮ‬ ‫داﺷﺖ ﻛﮫ ‪ PIP‬ﻣﮭﻤﺘﺮ اﺳﺖ ﯾﺎ ‪.Paw‬‬ ‫ﻣﻮج ﻣﺮﺑﻊ و ﻣﻮج اﻓﺰاﯾﺶ ﯾﺎﺑﻨﺪه از ﻟﺤﺎظ ﺧﺼﻮﺻﯿﺎت ﺷﺒﯿﮫ ﯾﻜﺪﯾﮕﺮﻧﺪ و از‬ ‫•‬ ‫ﻃﺮﻓﻲ ﻣﻮج ﻛﺎھﺶ ﯾﺎﺑﻨﺪه و ﻣﻮج ﺳﯿﻨﻮﺳﻲ ﻧﯿﺰ ﺷﺒﯿﮫ ھﻢ ﻣﻲ ﺑﺎﺷﻨﺪ.‬ ‫در ﻣﻮج ﻣﺮﺑﻊ و اﻓﺰاﯾﺶ ﯾﺎﺑﻨﺪه ﻣﯿﺰان ‪ ) PIP‬ﺑﻄﻮر ﻣﺘﻮﺳﻂ 5.62( و ‪) Paw‬‬ ‫•‬ ‫6.4( ﻣﻲ ﺑﺎﺷﺪ. در ﻣﻮج ﻛﺎھﺶ ﯾﺎﺑﻨﺪه و ﺳﯿﻨﻮﺳﻲ ‪ ) PIP‬ﺑﻄﻮر ﻣﺘﻮﺳﻂ ٢٢(‬ ‫و ‪ (٥)paw‬ﻣﻲﺑﺎﺷﺪ.‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  24. 24. ● Peak Airway Pressure:- • In adults if the peak airway pressure is persistently above 45 cmH2O, the risk of barotrauma is increased and efforts should be made to try to reduce the peak airway pressure. • In infants and children it is unclear what level of peak pressure may cause damage. In general, keeping peak pressures below 30 is desirable.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  25. 25. ‫‪Sigh‬‬ ‫• ھﺪف از دم ﻋﻤﯿﻖ ﻣﻘﺎﺑﻠﮫ ﺑﺎ اﻧﺴﺪاد راھﮭﺎي ھﻮاﺋﻲ ﻛﻮﭼﻚ اﺳﺖ ﻛﮫ‬ ‫ﻣﻤﻜﻦ اﺳﺖ در ﺻﻮرت اراﺋﮫ ﺣﺠﻢ ﺟﺎري ﯾﻜﻨﻮاﺧﺖ ﺑﺮوز ﻧﻤﺎﯾﺪ.‬ ‫• ﺣﺠﻢ ‪ ٥/١ sigh‬ﺗﺎ ٢ ﺑﺮاﺑﺮ ﺣﺠﻢ ﺟﺎري و ﺗﻌﺪاد آن ٤ ﺗﺎ ٦‬ ‫ﻣﻲﺑﺎﺷﺪ.‬ ‫• در ﺣﺠﻢھﺎي ﺟﺎري ﺑﺎﻻ ﯾﺎ ﺑﻜﺎرﮔﯿﺮي ‪ peep‬ﻧﯿﺎزي ﺑﮫ ‪sigh‬‬ ‫ﻧﯿﺴﺖ.‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  26. 26. ● Sensitivity(trigger Sensitivity) • The sensitivity function controls the amount of patient effort needed to initiate an inspiration • Increasing the sensitivity (requiring less negative force) decreases the amount of work the patient must do to initiate a ventilator breath. • Decreasing the sensitivity increases the amount of negative pressure that the patient needs to initiate inspiration and increases the work of breathing.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  27. 27. ‫)‪Pressure Trigger(sensitivity‬‬ ‫ﺗﻨﻈﯿﻢ ﺣﺴﺎﺳﯿﺖ ﻧﻤﺎﯾﺎﻧﮕﺮ ﻣﻘﺪار اﻓﺖ ﻓﺸﺎر در زﯾﺮ ﺧﻂ ﭘﺎﯾﮫ ) اﻧﺘﮭﺎي ﺑﺎزدم(‬ ‫•‬ ‫اﺳﺖ ﻛﮫ ﺑﯿﻤﺎر ﺑﺎﯾﺴﺘﻲ در ﻣﺪار وﻧﺘﯿﻼﺗﻮر اﯾﺠﺎد ﻛﻨﺪ ﺗﺎ ﻣﻮﺟﺐ ﺗﺤﺮﯾﻚ دﺳﺘﮕﺎه‬ ‫ﺟﮭﺖ اراﺋﮫ ﺣﺠﻢ ﺟﺎري ﺗﻨﻈﯿﻤﻲ ﺑﺮ روي آن ﺷﻮد.‬ ‫ﺑﺎ ﺗﻨﻈﯿﻢ ﺻﺤﯿﺢ ﻛﻠﯿﺪ ﺣﺴﺎﺳﯿﺖ، ﻣﻲﺗﻮان ﭘﺎﺳﺦ ﺗﮭﻮﯾﮫاي دﺳﺘﮕﺎه را ﺑﺎ ﻛﻮھﺶ‬ ‫•‬ ‫ﺗﻨﻔﺴﻲ ﺑﯿﻤﺎر ھﻤﺎھﻨﮓ ﻧﻤﻮد.‬ ‫ﻣﻘﺪار آن از ٠/٥- ﺗﺎ ٠١- ﺳﺎﻧﺘﯿﻤﺘﺮ آب ﻗﺎﺑﻞ ﺗﻨﻈﯿﻢ اﺳﺖ.‬ ‫•‬ ‫ﻣﻘﺪار ﺗﻨﻈﯿﻢ ﺑﺎﯾﺴﺘﻲ٥/ ١-٥ /٠ﺳﺎﻧﺘﯿﻤﺘﺮ آب زﯾﺮ ‪ baseline‬ﺑﺎﺷﺪ.‬ ‫•‬ ‫در ﻣﺪ ‪ SIMV‬ﻓﺸﺎر ﻣﻨﻔﻲ ﻻزم ﺑﺮاي ﺗﺤﻮﯾﻞ دم اﺟﺒﺎري ﺗﻮﺳﻂ وﻧﺘﯿﻼﺗﻮر‬ ‫•‬ ‫ﻧﺒﺎﯾﺪ از ١- ﺗﺎ ٢- ﺳﺎﻧﺘﯿﻤﺘﺮ آب ﺑﯿﺸﺘﺮ ﺑﺎﺷﺪ زﯾﺮا ھﺪف از ﺗﻨﻈﯿﻢ ﺣﺴﺎﺳﯿﺖ در‬ ‫ﻣﺪ ‪ SIMV‬ھﻤﺎھﻨﮓ ﻛﺮدن دم اﺟﺒﺎري ﺑﯿﻤﺎر ﺑﺎ ﺷﺮوع دم ارادي اﺳﺖ.‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  28. 28. ‫)‪Flow Trigger ( Flow By‬‬ ‫‪ Base flow‬ﺑﺮاﺑﺮ ﺑﺎ ﺗﮭﻮﯾﮫ دﻗﯿﻘﮫاي ﺑﯿﻤﺎر و ‪ sense flow‬ﻧﺼﻒ ‪ base‬ﯾﺎ‬ ‫•‬ ‫ﺣﺪاﻗﻞ ١.‬ ‫‪ Base flow‬ﺑﺮاﺑﺮ ﺗﮭﻮﯾﮫ دﻗﯿﻘﮫ اي ﺑﯿﻤﺎر و ‪ ١-٣ sense‬ﻟﯿﺘﺮ زﯾﺮ ‪base‬‬ ‫•‬ ‫‪flow‬‬ ‫وزن ﻛﻤﺘﺮ از ٥٢ ﻛﯿﻠﻮﮔﺮم ‪ ١ sense‬ﻟﯿﺘﺮ در دﻗﯿﻘﮫ ) ‪(small patient‬‬ ‫•‬ ‫وزن ٥٢ ﺗﺎ ٠٥ ﻛﯿﻠﻮﮔﺮم ‪ ٢ sense‬ﻟﯿﺘﺮ در دﻗﯿﻘﮫ‬ ‫•‬ ‫وزن ﺑﯿﺸﺘﺮ از ٠٥ ﻛﯿﻠﻮﮔﺮم ‪ ٣ sense‬ﻟﯿﺘﺮ در دﻗﯿﻘﮫ ) ﺑﺰرﮔﺴﺎﻻن(‬ ‫•‬ ‫ﺣﺪاﻗﻞ ‪ ٥ baseflow‬ﻟﯿﺘﺮ در دﻗﯿﻘﮫ و ﺣﺪاﻛﺜﺮ آن ٠٢ ﻟﯿﺘﺮ در دﻗﯿﻘﮫ. اﮔﺮ‬ ‫•‬ ‫‪ base flow‬زﯾﺎد ﺑﺎﺷﺪ ﻣﻮﺟﺐ اﻓﺰاﯾﺶ ‪ Peep‬و اﻓﺰاﯾﺶ ﻓﺸﺎر راه ھﻮاﺋﻲ‬ ‫ﻣﻲﺷﻮد.‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  29. 29. ‫)‪Plateau ( Pause‬‬ ‫در اﯾﻦ روش در ﭘﺎﯾﺎن دم درﯾﭽﮫ ﺑﺎزدﻣﻲ ﻣﺴﺪود ﺷﺪه، ھﻮا ﺑﮫ ﻣﺪت ﻛﺴﺮي از‬ ‫•‬ ‫ﺛﺎﻧﯿﮫ در رﯾﮫ ھﺎ ﻣﺘﻮﻗﻒ ﻣﯿﮕﺮدد. اﯾﺠﺎد وﻗﻔﮫ در اﻧﺘﮭﺎي دم ﻣﻮﺟﺐ ﺣﻔﻆ ﺑﺎد‬ ‫ﺷﺪﮔﻲ رﯾﮫھﺎ ﺑﺮاي ﯾﻚ دوره زﻣﺎﻧﻲ اﺧﺘﺼﺎﺻﻲ ) ﻣﻌﻤﻮﻻ ﻛﻤﺘﺮ از ٢ ﺛﺎﻧﯿﮫ(‬ ‫ﻣﻲﺷﻮد.‬ ‫ﺗﻮﻗﻒ ھﻮا در اﻧﺘﮭﺎي دم ﺑﮫ اﻧﺘﺸﺎر ﺑﯿﺸﺘﺮ ھﻮا در ﻗﺴﻤﺘﮭﺎي ﻣﺤﯿﻄﻲ رﯾﮫ ﻛﻤﻚ‬ ‫•‬ ‫ﻣﻲﻛﻨﺪ و ﻣﻮﺟﺐ ﻛﺎھﺶ ﻧﻮاﺣﻲ ﺗﮭﻮﯾﮫ، ﻓﻀﺎي ﻣﺮده و ﺷﻨﺖ ﺷﺪه ﺑﮫ ﺑﮭﺒﻮد‬ ‫ﺗﺒﺎدل ﮔﺎزي ﺑﯿﻦ ﺧﻮن ﻛﺎﭘﯿﻠﺮي و ھﻮاي داﺧﻞ آﻟﻮﻟﮭﺎ ﻛﻤﻚ ﻣﻲﻛﻨﺪ.‬ ‫زﻣﺎن وﻗﻔﮫ دﻣﻲ ﺑﮫ زﻣﺎن دم اﺿﺎﻓﮫ ﺷﺪه و از زﻣﺎن ﺑﺎزدم ﻛﺎﺳﺘﮫ ﻣﻲﺷﻮد.‬ ‫•‬ ‫اﺳﺘﻔﺎده از وﻗﻔﮫ اﻧﺘﮭﺎي دﻣﻲ اﺟﺎزه ﻣﻮﻧﯿﺘﻮرﯾﻨﮓ ﻛﻤﭙﻠﯿﺎﻧﺲ و ﻣﻘﺎوﻣﺖ را ﻣﻲ‬ ‫•‬ ‫دھﺪ.‬ ‫ﻓﺸﺎر ﭘﻼﺗﻮ ﻣﻨﻌﻜﺲ ﻛﻨﻨﺪه ﻓﺸﺎر داﺧﻞ آﻟﻮﺋﻮﻟﻲ اﺳﺖ ﻛﮫ از آن ﺟﮭﺖ ﻛﻤﭙﻠﯿﺎﻧﺲ‬ ‫•‬ ‫اﺳﺘﺎﺗﯿﻚ اﺳﺘﻔﺎده ﻣﻲﺷﻮد.‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  30. 30. ‫‪Peak Flow‬‬ ‫ﺳﺮﻋﺖ ﺟﺮﯾﺎن ھﻮا در ﻃﻮل دم ﻛﮫ ﺑﺮ ﺣﺴﺐ ﻟﯿﺘﺮ در دﻗﯿﻘﮫ ﻣﺤﺎﺳﺒﮫ ﻣﻲﺷﻮد.‬ ‫•‬ ‫ﺗﻨﻈﯿﻢ ‪ Peak flow‬ﺑﺎ ﺗﻮﺟﮫ ﺑﮫ ﺗﻌﺪاد ﺗﻨﻔﺲ ﺑﯿﻤﺎر در دﻗﯿﻘﮫ و ﺣﺠﻢ ﺟﺎري‬ ‫•‬ ‫ﺗﻨﻈﯿﻤﻲ ﺑﺮ روي دﺳﺘﮕﺎه اﺳﺖ. راﺑﻄﮫ ‪ flow‬ﺑﺎ زﻣﺎن دم و ﺣﺠﻢ ﺟﺎري ﺑﮫ‬ ‫ﺻﻮرت ‪VT=F×Ti‬‬ ‫‪ Flow‬زﯾﺎد ﻣﻨﺠﺮ ﺑﮫ ﻛﻮﺗﺎه ﺷﺪن زﻣﺎن دم، اﻓﺰاﯾﺶ ‪ PIP‬و ﺗﻮزﯾﻊ ﻛﻢ ﮔﺎز در‬ ‫•‬ ‫رﯾﮫ ﻣﻲﮔﺮدد.‬ ‫‪ Flow‬ﻛﻢ ﻣﻨﺠﺮ ﺑﮫ ﻛﺎھﺶ ‪ ،PIP‬ﺗﻮزﯾﻊ ﺑﮭﺘﺮ ﮔﺎز در رﯾﮫ، اﻓﺰاﯾﺶ ‪،Paw‬‬ ‫•‬ ‫ﻃﻮﻻﻧﻲ ﺷﺪن زﻣﺎن دم، ﻛﻮﺗﺎه ﺷﺪن زﻣﺎن ﺑﺎزدم و ‪ ،air trapping‬اﺛﺮات‬ ‫ﻧﺎﻣﻄﻠﻮب ﺑﺮ روي ﺳﯿﺴﺘﻢ ﻗﻠﺒﻲ-ﻋﺮوﻗﻲ‬ ‫‪ Flow‬ﺑﺎﯾﺴﺘﻲ ﻃﻮري ﺗﻨﻈﯿﻢ ﺷﻮد ﻛﮫ ﻧﺴﺒﺖ دم ﺑﮫ ﺑﺎزدم از٥/ ١:١ ﺗﺎ ٤:١‬ ‫•‬ ‫ﺷﻮد. ‪ Flow‬ﺑﺮ ﺣﺴﺐ ﻧﯿﺎز ﺑﯿﻤﺎر ﺑﺎ دﻗﺖ ﺗﻨﻈﯿﻢ ﺷﻮد.‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  31. 31. Ensuring humidification and thermo regulation • All air delivered by the ventilator passes through the water in the humidifier, where it is warmed and saturated. • Humidifier temperatures should be kept close to body temperature 35 ºC- 37ºC. • In some rare instances (severe hypothermia), the air temperatures can be increased. • The humidifier should be checked for adequate water levelsCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  32. 32. ‫‪Alarm system‬‬ ‫• ‪ : Alarm system‬ﺷﺪت آﻻرم ﻣﺘﻨﺎﺳﺐ ﺑﺎ وﺧﺎﻣﺖ‬ ‫اﺧﺘﻼل اﯾﺠﺎد ﺷﺪه ﻣﻲ ﺑﺎﺷﺪ.‬ ‫– ﺷﻨﯿﺪاري‬ ‫– دﯾﺪاري‬ ‫• آﻻرم اﻛﺴﯿﮋن‬ ‫– در ﺣﺪ ﺑﺎﻻﺗﺮ و ﭘﺎﯾﯿﻦ ﺗﺮ از2‪ FIO‬ﺗﻨﻈﯿﻢ ﻣﻲ ﺷﻮد‬ ‫– ﻋﻠﻞ:‬ ‫• ﺗﻐﯿﯿﺮ ﻋﻤﺪي 2‪FIO‬‬ ‫• ﺧﻄﺎي آﻧﺎﻟﯿﺰور اﻛﺴﯿﮋن‬ ‫• اﺷﻜﺎل در ﻣﻨﺒﻊ اﻛﺴﯿﮋن‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  33. 33. ‫• آﻻرم ﻓﺸﺎر‬ ‫– ‪:High pressure limit‬‬ ‫• ٠١ ‪ cm H2O‬ﺑﺎﻻﺗﺮ از ‪ PIP‬ﺗﻨﻈﯿﻢ ﻣﻲ ﺷﻮد‬ ‫• ﻋﻠﻞ:‬ ‫اﻧﺴﺪاد راه ھﻮاﯾﻲ‬ ‫–‬ ‫ﻛﺎھﺶ ﻛﻤﭙﻠﯿﺎﻧﺲ رﯾﮫ: ﭘﻨﻮﻣﻮﺗﻮراﻛﺲ, ‪ ,ARDS‬آﺗﻠﻜﺘﺎزي, اﺳﻜﺎر ﺳﻮﺧﺘﮕﻲ‬ ‫–‬ ‫ھﻨﮕﺎم ‪sigh‬‬ ‫–‬ ‫‪ ,gaging‬ﺳﺮﻓﮫ ﻛﺮدن‬ ‫–‬ ‫‪Fighting‬‬ ‫–‬ ‫– ‪:Low pressure limit‬‬ ‫• ٥-٠١‪ cmH2O‬ﭘﺎﯾﯿﻦ ﺗﺮ از ‪PIP‬ﺗﻨﻈﯿﻢ ﻣﻲ ﺷﻮد‬ ‫• ﻋﻠﻞ:‬ ‫– ﻗﻄﻊ ارﺗﺒﺎط ﺑﯿﻤﺎر از وﻧﺘﯿﻼﺗﻮر‬ ‫– وﺟﻮد ﻧﺸﺖ در ﺳﯿﺴﺘﻢ‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  34. 34. :Low oxygen pressure alarm • ‫– ﻋﻠﺖ ﭘﺎﯾﯿﻦ ﺑﻮدن ﻓﺸﺎر در ﻣﻨﺒﻊ اﻛﺴﯿﮋن وﻧﺘﯿﻼﺗﻮر ﻣﻲ ﺑﺎﺷﺪ‬ :Low air pressure alarm • ‫– ﻋﻠﺖ ﭘﺎﯾﯿﻦ ﺑﻮدن ﻓﺸﺎر ھﻮاي ﻓﺸﺮده و ﯾﺎ ﺧﺮاﺑﻲ ﻛﻤﭙﺮﺳﻮر‬ ‫دﺳﺘﮕﺎه ﻣﻲ ﺑﺎﺷﺪ‬ :Low PEEP/CPAP alarm • PEEP/CPAP ‫ ﭘﺎﯾﯿﻦ ﺗﺮ از ﻣﯿﺰان‬cmH2O٥-٣ – ‫– ﻋﻠﺖ وﺟﻮد ﻧﺸﺖ در ﻣﺪار ﺗﮭﻮﯾﮫ ﻣﻲ ﺑﺎﺷﺪ‬Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  35. 35. ‫• ‪: Volume alarm‬‬ ‫– ‪Low exhaled tidal volume or minute‬‬ ‫‪ventilation‬‬ ‫• ٠١% ﻛﻤﺘﺮ از ‪ T.V‬و ﯾﺎ‪VE‬ﺗﻨﻈﯿﻢ ﻣﻲ ﺷﻮد‬ ‫• ﻋﻠﻞ:‬ ‫– ﻧﺸﺖ در ﺳﯿﺴﺘﻢ ﺗﻨﻔﺴﻲ‬ ‫– ﻛﺎھﺶ ﻛﻤﭙﻠﯿﺎﻧﺲ و ﯾﺎ اﻓﺰاﯾﺶ ﻣﻘﺎوﻣﺖ رﯾﻮي در ‪ mode‬ﻓﺸﺎري‬ ‫– ﻣﺮﻃﻮب ﺷﺪن ‪flow sensor‬‬ ‫– ‪High exhaled tidal volume or minute‬‬ ‫‪ventilation‬‬ ‫• ٥١-٠١ % ﺑﺎﻻﺗﺮ از ‪ T.V‬و ﯾﺎ‪VE‬ﺗﻨﻈﯿﻢ ﻣﻲ ﺷﻮد‬ ‫• ﻋﻠﻞ:‬ ‫اﻓﺰاﯾﺶ ﺗﻌﺪاد ﺗﻨﻔﺲ ﯾﺎ ﺣﺠﻢ ﺟﺎري‬ ‫–‬ ‫ﺗﻨﻈﯿﻢ ﻧﺎﻣﻨﺎﺳﺐ وﻧﺘﯿﻼﺗﻮر‬ ‫–‬ ‫ﺗﻨﻈﯿﻢ اﺷﺘﺒﺎه ﻛﻠﯿﺪ ﺣﺴﺎﺳﯿﺖ‬ ‫–‬ ‫وﺟﻮد آب در ﻟﻮﻟﮫ ھﺎي وﻧﺘﯿﻼﺗﻮر‬ ‫–‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  36. 36. ‫• ‪High/low respiratory rate alarm‬‬ ‫– ﻋﻠﺖ ﺗﻐﯿﯿﺮ ﺗﻌﺪاد ﺗﻨﻔﺲ ﺑﯿﻤﺎر از ﺣﺪود ﺗﻌﯿﯿﻦ ﺷﺪه‬ ‫• ‪Apnea alarm‬‬ ‫– زﻣﺎﻧﻲ ﻓﻌﺎل ﻣﻲ ﺷﻮد ﻛﮫ در ﻣﺪت زﻣﺎن ﺗﻨﻈﯿﻢ ﺷﺪه )ﻣﻌﻤﻮﻻ ٠٢ ﺛﺎﻧﯿﮫ(‬ ‫ھﯿﭻ ﮔﻮﻧﮫ ﺗﻼش ﺗﻨﻔﺴﻲ اﻧﺠﺎم ﻧﺸﻮد‬ ‫– ﻋﻠﻞ:‬ ‫• ﻋﺪم ﺗﻼش ﺗﻨﻔﺴﻲ ﺑﯿﻤﺎر‬ ‫• ﺷﻞ ﺷﺪن راﺑﻂ ﻣﺮﺑﻮط ﺑﮫ ‪flow sensor‬‬ ‫• ‪I:E ratio alarm‬‬ ‫– ﻋﻠﺖ ﺗﻨﻈﯿﻢ ﻧﺎﻣﻨﺎﺳﺐ وﻧﺘﯿﻼﺗﻮر ﻣﻲ ﺑﺎﺷﺪ‬ ‫• ‪Inoperative ventilator/machine failure alarm‬‬ ‫– ﻋﻠﻞ:‬ ‫• ﻗﻄﻊ ﺑﺮق‬ ‫• اﻓﺖ ﻓﺸﺎر اﻛﺴﯿﮋن ﯾﺎ ھﻮا‬ ‫• اﺧﺘﻼل در ﻋﻤﻠﻜﺮد ﺳﺨﺖ اﻓﺰاري وﻧﺘﯿﻼﺗﻮر‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
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  38. 38. Common terms • PIP = Peak Inspiratory Pressure • Peep = Positive End Expiratory Pressure • Frequency = rate of ventilation (20 – 40 bpm) • I – time = Inspiratory time (.2 - .8 seconds) • MAP = Mean airway pressure • Tidal Volume = amount of air inhaled in a single breath • Minute VentilationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  39. 39. Neonatal Ventilation • Time Cycled and Pressure Limited Ventilation – Inspiration is stopped when the selected inspiratory time has been reached – PIP is the maximum amount of pressure exerted on the patient’s airway during the inspiration – Initial values = 16-20 cmH20 of PIP – Good chest rise and Good breath soundsCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  40. 40. Neonatal Ventilation • Peep = Positive pressure maintained in the patient’s airway during expiration – Prevents collapsed alveoli – Increases FRC – Improves compliance – Improves oxygenation – Decreases intrapulmonary shunting – Allows for lower PIPs to be usedCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  41. 41. CPAP vs PEEP • Same distending alveolar pressure • PEEP is used in conjunction with ventilator rate • CPAP is used in spontaneously breathing patientCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  42. 42. Methods of administering CPAP • Endotracheal Tube – Patent airway, airway clearance – Disadvantage: plugging, malacia, infection • Nasal Prongs – Decrease infection, no malacia – Disadv. = plugging,pressure necrosis, gastric distention • Nasopharyngeal – Pressure necrosis, infection • Face Mask – Temporary measure prior to intubation or for apnea episodeCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  43. 43. Most popular method • High flow nasal cannulaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  44. 44. MAP • Most powerful influence on oxygenation • Average pressure exerted on the airway and lungs for the entire breath cycle • Affected by: PIP,PEEP,I-Time, Rate • High levels can lead to decreased CO, pulmonary hypoperfusion and barotraumaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  45. 45. Target Values: MAP Mean Airway Pressure • Average pressure exerted on the airways from the start of one inspiration until the next • Is affected by IT, PIP, Rate, and PEEP • Baro/Volutrauma seen with values above 12 cmH2O • It is the most powerful influence on oxygenation!Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  46. 46. Indications for Vent Support • Respiratory Failure – Hypoxemic respiratory failure • PaO2 less than 50 on FIO2 greater than 60 – Hypercapnic respiratory failure • PaCO2 greater than 50 and pH less than 7.25 – Mixed respiratory failure • Both hypoxemia and hypercapniaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  47. 47. Target Values: ABGs • pH: 7.25 – 7.45 • PaCO2: 35-55 mmhg – Increased chances of intracranial bleed if above 55 mmhg • PaO2: 50 – 70 mmhg – Capillary is 35 – 50 mmhgCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  48. 48. Initial Setting on neonatal vent • Time cycled – Pressure Limited ventilator – PIP set 15 – 20 cm H20 – Peep set 3 – 5 cm H2O – Rate set 20 – 40 bpm – Flow set 6 – 8 lpm – I time set .3 - .5 seconds for LBW and .5 - .8 seconds for larger infantsCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  49. 49. Settings • PIP – good chest excursion, good lung aeration • Vt in pressure control = PIP – PEEP • Vt in pressure control changes with change in compliance and resistanceCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  50. 50. Blood gas analysis • Normal values (1 hr age, not ventilated) – Preterm: pH 7.28-7.32, PCO2 35-45, PO2 50-80 – Term: pH 7.30-7.35, PCO2 35-45, PO2 80-95 • Remember! O2 content determined mostly by SpO2 and Hb%.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  51. 51. Ventilator settings • PEEP: – affects MAP (PO2), affects VT (PCO2) depending on position on P-V curve Volume PEEP PIP Pressure – older infants (e.g. BPD) tolerate higher levels of PEEP (6-8 cm H2O) better – RDS: minimum 2-3, maximum 6 cm H2O.Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
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