Ventilation strategies

1. Ventilation strategies Dr R Mathur

2. Learning objectives To know basics of ventilation When to ventilate / when not to ventilate What to do when patient deteriorates Troubleshooting Complications of ventilation How to use ventilators

3. Common terms O2 = Oxygen (Fi O2) Rate PIP PEEP IT MAP Frequency, Delta P etc.

4. Pressure time curve

6. Types of ventilation • Volume ventilation: Volume is constant and pressure will vary with patient’s lung compliance. • Pressure ventilation: Pressure is constant and volume will vary with patient’s lung compliance.

12. Indications of ventilation RDS MAS GBS pneumonia HIE PPHN Sepsis Head injury Asthma Bronchiolitis ?

13. Modes of ventilation High flow CPAP SIMV CMV PSV / PTV HFOV

14. Setting a ventilator Connect to electricity Connect gases Connect the circuit Fill in water in Humidifier (specially in HFOV) Set Rate,FiO2, PIP, PEEP, IT, Flow rate, alarms Test lung Check that it’s working before connecting to baby!

15. Troubleshooting Ventilation problem Oxygenation problem CO2 clearance problem Patient not settled Alarms

16. Patient desaturatingWhat do you do next? ? Check ventilator settings Connections Tube in correct position Pneumothorax

18. Oxygenation problem – what’ll you change first? O2 PEEP ?Rate PIP IT Mode?

19. CO2 clearance issues Rate PIP PEEP IT Mode? HFOV ? Paralyse

20. Initial settings 1 kg 28 week Respiratory Distress Syndrome – To be intubated & given Surfactant Rate FiO2 PIP PEEP IT What next??

21. Bigger baby Term,4 kg, MAS, Sats 75% in air at 30 min age Rate FiO2 PIP PEEP IT ? S ? NO

22. 10 year old Status Epilepticus – Previously fit & well. Settings Rate FiO2 PIP PEEP IT What next??

23. Summary of what you’ve learnt today Basics of ventilation When to ventilate How to connect ventilator to patient What helps oxygenation most effectively What needs to be done to clear CO2 How to troubleshoot When to extubate

24. Any questions???