This document discusses optimal inspiratory time (Ti) settings for mechanical ventilation in pediatric and neonatal patients. It provides recommended Ti ranges based on patient age and describes how Ti relates to other ventilation parameters like respiratory rate, I:E ratio, and time constant. Long Ti can cause patient-ventilator asynchrony and increase mortality risk, while shorter Ti has been shown to reduce air leaks and complications. The document discusses clinical applications of adjusting Ti in conditions like RDS, ARDS, and asthma.

1. ventilatory dynamics
I:E Ratio
10pediatric and neonatal mechanical ventilation
Tageldin Aly
part 10

2. Objectives
Normal range (ages )
Short Ti vs. long Ti
Short vs. long Te
Ti vs. RR
Inverse Ti: Te ratio
Clinical application

3. Recommended inspiratory time
ranges
•. 0.25–0.35 s in preterm infants
• 0.4–0.6 s in those at full term
• 0.4–0.6 s for infants
• 0.5-0.7 s for children
• 0.7-1 s for adolescent

4. Time constant (CXR ) vs. Ti

5. what is (OPTIMAL )Ideal Ti time?
What are the clinical applications ?

6. Role of OPTIMAL Ti time
(MAP and oxygenation)

7. Physiological ratio of I:E
depend on alveolar dispensability and compliance status

8. Ti time more helpful than I:E ratio in
neonate
Don’t look to I:E ratio in neonate
More precise
If you control Ti time automatic will control
the I: E ratio

9. Inverse‐ ratio ventilation the
inspiratory time (IT) is prolonged

10. inspiratory exceeded expiratory times
(reversed I:E ratios)
What will occur if you increase
the inspiratory time ?

12. You will kill the patient …

13. Clinical trials comparing long T I (0.66-1.0 s) with short T I (0.33–
0.5 s)
subsequently demonstrated an advantage in the shorter T I
group, including a slight reduction in mortality and a clear
decrease in the risk of air leak, particularly in infant with RDS.

14. Long Ti induced
patent –ventilation asynchrony
Correct inspiratory time not sedation
Inappropriately long set T I may lead to
dyssynchrony, with the infant exhaling against
the ventilator inflation pressure.
pediatric and neonatal mechanical ventilation

15. patent –ventilation asynchrony

16. RR))Ti vs. Respiratory rate
Check inspiratory time (Ti)
with every change in
Respiratory rate
RR = Ti
inversely proportion
Inverse the I:E ratio
You will kill your the patient

17. Is there any problem with long
Te ?
• RR = 20
• 60/20 = 3
• Ti = 0.35
• I: E = 1:6

19. Ti setting variations

20. Clinical Application
ARDSAsthmaITEMS
HIGHLowPEEP
InverseIncreaseI:E ratio

21. Clinical Application
RDS (ARDS),CLD (Asthma)

22. Ti: Te ratio

23. Te time exceed Ti time

24. Ti time interpretation on
waveform

28. Clinical application of Ti time

29. Clinical application of Ti time

31. Thank you

32. Thank you

35. Parameter effect

40. •Advantages of PTV
•Better synchrony help to ↓ patient discomfort
. Oxygenation may improve. Possible of air
leak ↓ . ↓ Work of breathing. ↓ Duration
of ventilation. If low pco2 on A/C ↓PIP or if
already on low PIP consider switching to low
rate SIMV (not