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Mv in neonates gokul
The document discusses the basics of neonatal ventilation, covering indications, settings, techniques, complications, and weaning strategies. It highlights two main approaches: non-invasive and invasive ventilation, detailing specific methods such as CPAP and high-frequency ventilation, along with troubleshooting and complications associated with mechanical ventilation. Additionally, it emphasizes the importance of careful weaning and the potential risks of mechanical ventilation in neonates, underlining the need for optimal ventilation practices.
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Mv in neonates gokul
- 1. BASICS OF NEONATALVENTILATION Instructor: Mr. Gokul Krishna G BSRT MSRT (NPRC) Assistant Professor Department of Respiratory Therapy Batterjee Medical college, Jeddah, KSA
- 2. CONTENTS ü INDICATIONS ü SETTINGS üTROUBLE SHOOTING ü COMPLICATIONS ü WEANING
- 3. Respiratory depression Surfactant deficiency Fluid filled lungs C-section absence of labour Limited muscle strength Limitedability to establish FRC Compliant chest wall Preterm ˂ 37 Weeks Term 37-42 Weeks Post term ˃ 42 Weeks
- 4. Techniques of assistedventilation There are two approaches : Non-invasive ventilation • Continuous positive airway pressure • Heated high flow nasal cannula Invasive ventilation • Conventional ventilation • High frequency ventilation
- 5. Continuous Positive AirwayPressure (CPAP) • Most common ventilation modality in newborns. • Recruits the alveoli and keep it opens the lung at the level of FRC • Keeps it open at minimum constant pressure • Controlled PEEP is recommended in newborns who need more than normal resuscitation at birth but are breathing spontaneously.
- 7. Heated High FlowNasal Cannula (HHFNC) • HHFNC allows the delivery of oxygen or a mixture of oxygen and air at flow rates higher than the insp flow of neonates • Washout of nasopharyngeal dead space • Proven benefits in post Extubation in term infants.
- 10. INVASIVE VENTILATION DRAGGER BABYLOG8000 PLUS SLE 5000
- 11. Ventilator Settings • Modeof ventilation • Fraction of inspired oxygen (FIO2) • Tidal Volume (TV) • Peak Inspiratory Pressure (PIP) or Pressure control (PC) • Positive End Expiratory Pressure (PEEP) • Respiratory rate (RR)
- 12. Modes Of Ventilation •Pressure Control Ventilation (PC) • Volume Guaranteed Ventilation (VG) – Dual Control Mode • Synchronized Intermittent Mandatory Ventilation (SIMV) • Pressure Support Ventilation (PSV) • High Frequency Ventilation (HFV) SIMV+ PC – common mode
- 13. VENTILATOR PARAMETERS RANGE FIO20.21- 1.0 Flow 3-120 L/min Respiratory Rate 1-150 bpm Tidal volume 1-1000 ml/kg PIP 0-60 cmH20 PEEP/CPAP 0-60 cmH2O Trigger Level -10 - +60 cmH2O
- 16. IMPROVING OXYGENATION Flow PIP orPC FiO2 Mean airway pressure PEEP I:E ratio Oxygenation
- 17. IMPROVING VENTILATION RR TE Minute Ventilation TV orPC Ventilation Flow PEEP
- 19. Oxygen Saturation Target INFANTS Arterialoxygen level (PaO2 mmHg) Oxygen saturation range (SPO2 %) Preterm < 32 Weeks 50-70 88-92 Preterm ≥ 32 Weeks 60-80 90-95 Term & Post Term 60-80 90-95
- 20. Ventilator Troubleshooting • Toreduce cuff associated injury • High chance of endotracheal tube leak causing ventilator dyssynchrony. Uncuffed Endotracheal Tube
- 21. Ventilator Troubleshooting cont. •Deterioration of vital signs • Ventilatory alarm • Chest wall movement 21 “DOPE” D- Displacement of ETT O- Obstruction P- Pneumothorax E- Equipment failure
- 22. Complications of MechanicalVentilation • Alveolar over distention is a primary cause of complications encountered during mechanical ventilation and is a result of: – Volutrauma (Large tidal volumes) – Atelectrauma (Repetitive opening and closing of the terminal lung units at low lung volumes) – Barotrauma (High ventilating pressures) 22
- 23. Cardiovascular complications –Reduced cardiacoutput Oxygen toxicity –High FIO2 levels that have been applied for an extended period may result in tissue injury that alters lung function and gas distribution –Retinopathy of prematurity Hypoventilation, hyperventilation –Disconnection from the ventilator and unplanned extubation –High impedance to inflation –“Operator error” in establishing ventilation 23
- 24. When to decideweaning ? Primary illness resolved?? Hemodynamic stability? Oxygenation status ? Neuromuscular status Respiratory muscle strength Acid –base balance? ü. ü. ü. ü. ü. ü.
- 25. WEANING STRATEGY Assess theweaning readiness Setting should be reduced in small increment in every 4- 6 hours: PIP: 2-3 cm H2O FiO2: 5-10% (Reduce FiO2 to 80% before PEEP: 1 cmH2O; Rate: 5-10/min; I time: 0.3-0.4 seconds “Weaning should be attempted throughout the day, not just during rounds”
- 26. Weaning Dilemma’s ü Noweaning protocol is 100% accurate in predicting successful weaning and extubation – Physician dependent ü Weaning too slowly may be more dangerous than weaning too fast, as it may result in excessive lung injury and hypocarbia ü Early weaning will facilitate parental bonding and developmentally appropriate care.
- 27. Surfactant Therapy • Exogenoussurfactant replacement therapy has been established as an appropriate preventive and lung protective therapy for prematurity*. *AAP committee on Fetus and Newborn March 1999,pp 684-685 Prophylactic Vs Rescue INSURE Vs MIST
- 28. Chronic Lung Disease(CLD)/ BPD Fetal Lung Development Postnatal Lung Growth And Development Pulmonary Outcome Initiation Of Breathing Mechanical Ventilation Oxygen Infection Preterm Labour Preterm Delivery CANNALICULAR STAGE SACCULAR STAGE ALVEOLAR STAGE
- 29. “Lung Protective /Optimal/Gentle Ventilation” Optimal is the tidal volume that creates a homogeneous delivery of each breath to the open lung units without creating volutrauma “Optimize FRC” • Intrapulmonary shunt is decreased • Lung volume effects on cardiac output are minimized • Oxygen delivery is optimized
- 30. Summary • Mechanical ventilationis only a supportive care therapy always consider the risk Vs benefits before initiation. • Not just pressure excessive volume also causes ventilator Induced lung injury *volume guaranteed mode of ventilation. • Cautious use of FiO2 especially in preterm neonates. • Initiate weaning as soon as possible ; not too fast or too slow • Practice gentle or optimal ventilation establishing the FRC.
- 31. References: • Perinatal AndPediatric Respiratory Care 3rd Edition Brian K. Walsh • Assisted ventilation of the neonate 5th edition; Goldsmith and Karotkin
- 32. THANK YOU “ Whatis important is not how the lung open but do get it open and keep it open”
- 33.