Guidelines for setting up a Neonatal Ventilator: 1. Pt range: Neonate (Maximum VT = 40cc) 2.

Mode: Pressure Control (works best for un-cuffed ETT) 3. VT: a. <33 weeks gestation 4 6 cc/kg b. >33 weeks gestation or chronic 5 7 cc/kg 4. PIP: a. Maximum PIP settings: - <27 weeks gestation 24 CWP - 27 32 weeks gestation 26 CWP - 33 40 weeks gestation 28 CWP b. Start low (best to err on low side to prevent barotraumas.) c. Increase to obtain target VT and adequate chest rise d. Frequently monitor & adjust PIP to accommodate changes in lung compliance altering tidal volume. 5. PEEP: a. Start at minimum 4 5 CWP b. Increase to 6 7 CWP if FiO2 needs > 60% c. Adjust to maintain acceptable PaO2 and SpO2 d. 8 10 CWP PEEP if directed by physician e. Remember that PC setting is above PEEP 6. FiO2: a. Start low at 40% b. Adjust to maintain target SpO2 c. If SaO2 < target range, FiO2 may be increased by 25, & then allowing 4 minutes for stabilization after each change. (consider adjustment of PIP and PEEP also.) d. Continue assuring AW patent, HR>100 & baby not apneic. e. If SaO2 > target range, FiO2 may be decreased by 2 5, allowing 4 minutes for stabilization after each change. f. Consider increasing PEEP prior to FiO2 g. Maintain neonate on ROOM AIR whenever possible. 7. Rate: a. 50 60 if < 34 weeks gestation or < 3 kg b. 40 50 if >34 weeks gestation or > 3 kg c. 30 40 if 40 weeks gestation; slightly higher if indicated. d. Watch for air trapping at rates > 40 (adjust I-time). 8. I-time: a. Start at 0.3 plus or minus 0.5 (post-term may need more.) b. Neonatal initial I-time setting - <1kg 0.25 0.30 sec minimum 0.20 seconds - 1-2kg 0.30 0.40 sec minimum 0.20 seconds - 2-3kg 0.35 0.45 sec minimum 0.25 seconds - 3-4kg 0.40 0.60 sec minimum 0.30 seconds c. Ideally set using Flow-time graphics d. This alters I-time and I:E ratio e. Increase & decrease to reach target settings as appropriate f. Watch for air trapping at rates >40 in neonates >3kg; they may need I-time >0.40 to complete inspiration & prevent air trapping. g. If neonate using expiratory muscles, try decreasing I-time slightly (increasing flow). h. If I-time gets too short, consider switch to PRVC. 9. I-Rise time: a. 10 if < 33 weeks gestational age b. >5 if >33 weeks gestational age c. Basically, the smaller the ETT the higher this should be to create laminar flow and a pseudo sign wave. d. Increase for bronchospasm (slow rise time, longer e-time) 10. PIP limit: 2 3 > PIP (all other alarms as appropriate.)

Indications to intubating neo 1. PaO2 < 45mmHg while breathing 80 100% FiO2 2. PaCO2 > 65mmHg 3. Intractable metabolic acidosis(B.E. < -10 meq.) 4. Marked retractions on CPAP 5. Frequent episodes of apnea and bradycardia on CPAP.
Normal Neo ABGs & Vitals: 1. Target ABG: PH 7.25 7.40 PCO2 = 45 59 PaO2 = 50 70 BE = 0 -4 2. SpO2: 8292% if <27 wks 8593% if <33 wk 88 95% if >33 wks 2. RR: Term = 3050 Premie = 40 - 70 3. HR: Term =120 160 4. BP: 50 90 systolic 25 60 diastolic

Ideal Tidal Volume for neonates <33 weeks gestation (Based on 4-6 ml/kg IBW) Weight Min VT Max VT (kg) 0.5 2 3 1 4 6 1.5 6 9 2 8 12 2.5 10 15 3 12 18 Ideal tidal volume for neonates > 33 weeks gestation (Based on 5-7ml/kg IBW) Weight Minimum Maximum (kg) VT VT 1 5 7 2 10 14 3 15 21 4 20 28 5 25 35 6 30 42 7 35 49
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