Pediatric & Neonatal Mechanical Ventilation Praveen Khilnani
INDEX
A
Abnormal waveforms 119
Acidosis 76
Acute
lung injury (ALI) 128, 168
myocardial infarction (AMI) 233
pulmonary edema 168
respiratory distress syndrome 244
respiratory failure 172
Adjustments after initiation 42
Advanced mechanical ventilation 57
Advantages of NIPPV 168
Aerosol therapy 91
Air
leak syndrome 200
trapping 120
-entrainment mask/venturi mask 26
Airleak syndrome 48
Airway
injury from mechanical ventilation 163
pressure (PAW) 109, 110
pressure release ventilation (APRV) 58
resistance 9, 16
Alkalinization 80
Alkalosis 76
Altering inspired oxygen and carbon dioxide 64
Alternative modes of
neonatal ventilation 52
ventilation 196
Alveolar
capillary interface 23
overdistention 122
Anatomical dead space 10
Anterior horn cell disease 168
Apneic oxygenation 63
Applied respiratory physiology for mechanical ventilation 16
Approach to
child with acidosis 78
patient with alkalosis 81
ARDS controversies with INO therapy 232
Argyl nasal prongs 185
Art of ventilation 107
Artificial lung 198
Assessing outcome 200
Assist/control ventilation 52, 196
Assisted mode (volume-targeted ventilation) 124
Asthma 118
Asynchrony during SIMV-PS 66
Auto-peep or air trapping 119
Auto-triggering 70, 71
B
Barotrauma and oxygen toxicity (BPD) 200
Barotrauma/volutrama 162
Basic
concepts of HFV 203
fundamentals of ventilation 38
mechanical ventilation 34, 37
physiology 9, 35
principles of ventilation 194
respiratory physiology 9
Benefits of HFO 267
Benzodiazepines 138
Bi-level positive airway pressure (BIPAP) 168, 170
Blood gas
and acid-base interpretation 76
monitoring 200
parameters 193
Breath
cycling asynchrony 74
delivery asynchrony 71
Breathing circuit 2
Bronchiolitis 168
Bronchopulmonary dysplasia (BPD) 11
Bruises and erosions 176
Bubble nasal CPAP system 184
Buffering system 76
Bunnell jet ventilator 204
C
Cardiac case statistics 238
Cardiovascular factors 149
Care of ventilated patient 88
Cavopulmonary connection 168
Central nervous system (CNS) 147
Cerebral malaria 233
Cesar-trial 244
Characteristic flow-volume loops 119
Characteristics of aerosol generating device 91
Chest
mechanics 15
physiotherapy (CPT) 88
Child with severe tracheomalacia 119
Choose the mode 42
Chronic respiratory failure 170
Circuit
characteristics 92
disconnect alarm 269
Clinical
application 205
applications and significance 125
Collapse of upper airway 176
Common causes of extubation failure 159
Commonly
available ventilators 247
used nomenclature 36
Complication of invasive monitoring 200
Complications
and sequelae 200
associated with bubble nasal CPAP 188
of mechanical ventilation 162
of NIPPV 176
related to adjunctive therapies 165
Components of inflation pressure 113
Compressor 1
Conditions when CPAP fails 187
Conductance is reciprocal of resistance 11
Constant flow ventilation 63
Content of
oxygen (CAO2) 22
in blood 22
Continuous
positive airway pressure (CPAP) 27, 36, 50, 170, 194
rotational therapy 89
venovenous hemofilteration loop 244
Contraindications to CPAP 182
Control of respiration 15
Controlled
hypercapnia 46
hypoventilation (permissive hypercapnia) 142
mode (volume-targeted ventilation) 124
Conventional
neonatal ventilation 51
ventilation 195
CPAP delivery system 28, 182, 183
Criteria
for intubation 137
to assess ventilator dependence 150
Cycling off 70
Cystic fibrosis 168
D
Dead space ventilation 10
Decreased lung compliance during volume ventilation 121
Delayed termination 74
Descending ramp flow waveform 113
Determinants of weaning outcome 148
Diagnosing acute lung injury 128
Diaphragmatic palsy 168
Differences in high frequency jet ventilation 199
Diffusing capacity 14
Disease specific ventilation 45
Distribution of inspired gas 10
Double triggering 70
Drager Babylog 8000
controls 252, 253
plus 254
Duration of treatment 230
Dynamic hyperinflation 139, 142
E
ECMO
circuit 241
management 242
Effects of
CPAP in infant with respiratory disease 181
intubation 139
metabolic acidosis 79
Effects on
circulatory system 165
lung 163
Elevated pulmonary capillary wedge pressure 234
ELSO registry 2010 data 245
Endotracheal
intubation and ventilation 130
suctioning 94
Esophageal pressure (PES) 109
Evidence for CPAP 189
Extracorporeal membrane oxygenation 198, 237
Extubation after trial of CPAP 190
Extubation 158
Eye care 94
F
Factors affecting
mean airway pressure and oxygen 43
oxygen delivery ACI 23
Fiberoptic bronchoscopy (FOB) 89
Fixed upper airway obstruction 118
Flow
patterns 112
trigger sensitivity level 262
volume loop on spirometry 118
volume loop 110, 117, 118
vs volume 111
Fontan procedure 168
Forced
expiratory flow 118
inspiratory flow (FIF) 118
Fraction of bias flow 262
FVL indicates positive bronchodilator response 120
G
Gas exchange 18, 35
factors 149
related problems 42
Goals of
mechanical ventilation during weaning 156
ventilation in ARDS 47
Guillain-Barré syndrome 168
H
Heart transplantation 233
Heat and moisture exchangers (HMEs) 90
Heated
water humidifiers (HWHs) 90
wire circuit 90
Helium-oxygen mixture (heliox) 64
High flow 121
High frequency
jet ventilation (HFJV) 203
oscillation (HFO) 267
oscillatory ventilation (HFOV) 199, 204, 248
positive pressure ventilation (HFPP) 203
ventilation 53, 62, 197, 202, 203, 206
High PACO2 43
High raw 120
Homeostasis 77
Humidifier 2
Hypercarbia 18, 35
Hypoxemia 17, 35, 141
and hypoxia 23
I
Improved RDS with CPAP 187
Improves non-invasive ventilation 68
Improving patient ventilator synchrony 74
IMV modes 38
Inadequate oxygenation 42
Inadvertent (auto) peep 109
Increased airway resistance (RAW) 120
Indications for
CPAP 182
NIPPV 168
reintroducing NCPAP 189
Indications of mechanical ventilation 36
Ineffective trigger 70, 71
Infant
flow driver CPAP system 184
star 500/950 ventilator system 259
ventilator CPAP system 183
Inhaled
β-agonists 144
nitric oxide (INO) 54, 197, 227
Initial ventilator settings 41
Initiating and maintaining optimal NCPAP 182
Initiation of
non-invasive mechanical ventilation 172
ventilation 45, 193
Injury and ARDS in children 128
INO
in cardiology 233
in chronic lung disease 231
therapy in children with ARDS 231
Inspiratory time (TI) 2, 42
Inspired oxygen concentration (FIO2) 3
Intermittent mandatory ventilation (IMV) 155
Interpretation of respiratory alkalosis 84
Intubation technique 138
Inverse ratio ventilation (IRV) 57
K
Ketamine 138
Kyphoscoliosis 168
L
Life-threatening status asthmaticus 233
Limitations of NIPPV 174
Liquid ventilation (LV) 63, 199
Loops 117
Low functional residual capacity 16
Lung
compliance changes in P-V loop 121
infection 168
transplantation 233
M
Management of pediatric ALI and ARDS 129
Mandatory minute ventilation (MMV) 52, 196
Manual hyperinflation 89
Maquet 67
Mean airway pressure (Map) 2, 111
Measurement of
end-inspiratory plateau pressure 143
intrinsic positive end-expiratory 144
the end-inspired volume (VEI) 143
Measures
for high PACO2 43
to reduce barotrauma and volutrauma 44
Mechanical
misadventures 166
operational problems 162
ventilation in acute asthma 137
ventilation 9
Mechanism of improvement with non-invasive ventilation 167
Metabolic acidosis 77, 80
and respiratory alkalosis 86
factors and ventilatory muscle function 149
Meter dose inhaler (MDI) 92
Method linear regression analysis 253
Methods to monitor patients in ICU 108
Miscellaneous uses and ongoing trials 233
Mixed
acid-base disorders 85
metabolic alkalosis and respiratory acidosis 85
metabolic and respiratory acidosis 85
metabolic and respiratory alkalosis 85
Modes of ventilation 36, 122
Modified from recommendations by HESS 92, 93
Monitoring during NIPPV 175
Mucolytics 93
Muscle relaxation 200
Myasthenia gravis 168
N
Nasal
cannula 25
obstruction 188
Nasopharyngeal catheters 25
Naturally adjusted ventilatory assist 65
Neonatal
chronic lung disease 234
CPAP (continuous positive airway pressure) 181
intensive care unit (NICU) 247
respiratory case statistics 239
ventilation 50, 192
ventilator model bearcub 750
PSV–VIASYS H 250, 251
Neurally adjusted ventilatory assist (NAVA) 65
Neurologic issues 148
Neuromuscular
diseases 168
-blocking agents 139
Newer modes 57
Newport
wave E 120 258
breeze E 150 258
E 100 m ventilator 258
E 100 m 258
ventilators 258
Nitric oxide
delivery system 229
synthase (NOS) 227
NIV
double nasal tube 174
facial mask 174
via double nasal tube 174
via facial mask 173, 174
via tracheostomy 175
Nonconventional techniques 62
Noninvasive
mechanical ventilation 145
negative pressure ventilation (NINPV) 168
positive pressure ventilation (NIPPV) 169
ventilation 167, 171
Non-rebreathing masks 25
Normal
curve 120
flow-volume loop 119
Nosocomial
infections 162
pneumonias 165
O
Objectives of ventilation 195
Obstructive
pulmonary diseases 168
sleep apnea 168
Old and newer versions 256
Open heart surgery 49
Opioids 139
Other bronchodilators 145
Overdistention 122
Oxygen
carriage 14
concentrator 29
delivery devices 24
dissociation curve 23
hood 26
in arterial blood 21
therapy 20
toxicity 31
Oxygenation 17, 35
Oxyhemoglobin-dissociation curves 15
P
PAO2 and FIO2 is safe 32
Paradoxical worsening 234
Partial pressure of oxygen 20
in alveolus (PAO2) 35
Partial-rebreathing masks 25
Parts of a ventilator 1
Pathophysiology of ventilator dependence 147
Patient
comfort 175
on NIPPV 173
selection criteria 239
triggered ventilation (PTV) 52, 196
ventilator dyssynchrony 44, 70
with symptomatic severe asthma/cystic fiber 119
-ventilator synchrony 157
Peak
expiratory flow rate (PEFR) 118
inspiratory flow rate (PIFR) 118
inspiratory pressure (PIP) 13, 109, 111
Pediatric
intensive care unit (PICU) 247
respiratory case statistics 239
Percent survival without ECMO 229
Percussion and vibration 89
Permissive
hypercapnia 44
hypoxemia 44
Persistent pulmonary hypertension (PPHN) 34
Phrenic palsy, injury or disease 168
Physiological effects of INO in ARDS 232
PIP vs Pplat 120, 121
Plateau pressure (Pplat) 109
Pneumotaxic and apneustic 15
Position of device 92
Positive end expiratory pressure (PEEP) 1, 111, 141
Postoperative ventilation 49
Potential benefits with nava 67
Practical tips to approach acid-base disorders 84
Premature termination 74
Prerequisites to weaning 157
Pressure control
mode 140
ventilation 39, 169
Pressure
control 39
flowtrace 62
limited time cycled ventilation 51
limited 42
-regulated volume control (PRVC) 41, 61
regulated volume control (PRVC) 41, 62
support (PS) 38, 156
-support 7
support/CPAP 60
ventilation (PSV) 52, 60, 155, 170, 196, 267
ventilators 248
volume and flow against time 111
volume curve 110
-volume loop 117
Prevent gastric distention 188
Preventing injury to nasal septum 188
Prevention of barotrauma 164
Primary pulmonary hypertension 233
Principles of oxygenation 29
Procedure of weaning from mechanical ventilation 153
Procedures for removal of NCPAP 189
Product benefits 261
Prolonged bleeding time 234
Prophylactic CPAP in VLBW infants 190
Propofol 138
Proportional assist ventilation (PAV) 52, 61, 196
Protection from contaminants 268
Psychosocial factors 149
Pulmonary
capillary flow is best at functional 18
circulation: 162
or cardiac shunt 24
Puritan Bennett® 840 ventilator 268
R
Raised ICP (intracranial pressure) 50
Ramp flow waveforms comparing fast and slow space 114
Ratio of inspiratory to expiratory time 6
Rebound effects 234
Recent evidence on use of ECMO 244
Recognition of hypoxia 23
Rectangular flow waveforms
square wave 113
comparing fast and slow 114
Rescue therapies for children with ALI/ARDS 132
Respiratory
acidosis 82, 137
alkalosis 83
care protocol 45
control 66
failure on CPAP 188
failure 36
rate (RR) 2, 5, 111
support in children with ALI and ARDS 129
system muscle/load interactions 148
Respironics BIPAP 264
and non-invasive ventilator 264
Restrictive lung disease 118, 119
Routine ventilator management protocol 44
S
Scalar waveforms
during common modes of ventilation 123
of pressure and volume controlled 122
Scalars and loops 111
Sechrist ventilator
new 257
old 256
Sedation
and muscle relaxation during ventilation 44
during intubation and ventilation 138
Self-diagnostic testing 269
Sensor medics high frequency oscillatory ventilation 263
Sensormedics 3100A 263
oscillator 262
oscillator 205
Servo-I infant (MAQUET) 261
Severe RDS 187
Shortens weaning time 68
Shunt 13
Siemens servo 300/300A ventilator 255, 256
Siemens servo 900C ventilator 254, 255
Siemens servo 260
I (MAQUET) 260
Simple
humidifier 2
oxygen masks 25
SIMV + PS—volume-targeted ventilation 125
SIMV with pressure support (PS) 124
Sine flow waveform 113
SLE
2000 for infant ventilation 264
2000 265
5000 266
Smartalert™ alarm system 268
Specific ventilators 249
Structure and function of a conventional ventilation 1
Success with NCPAP 186
Suction support 262
Suggested method for delivery of drug by nebulization 92
Support mode 38
Supportive therapy with mechanical ventilation 200
Surgery on right heart 168
Synchronized intermittent mandatory ventilation (SIMV) 124
Systemic corticosteroids 144
T
Targeted tidal volume (TTV) 267
Technical specification 261, 265
Technique of respiratory mechanics monitoring 110
Terminology 2
Tetralogy of Fallot 168
Three types of CPAP delivery systems 182
Tidal volume (VT) 1, 6, 109
Time constant 36
resistance × compliance 11
Timely delivery of assistance 68
T-piece weaning 155
Tracheal insufflation of oxygen 63
Transairway pressure (PTA) 109
Transport ventilator 258
bird avian 258
Transpulmonary pressure 11, 109
Treatment of underlying cause 79
Trigger variable 71
Trigger/sensitivity 40
Triggering 70
Types of
high frequency ventilation 203
humidifiers 2
hypoxemia 24
ventilatory support 194
waveforms 111
U
Unresponsiveness to INO therapy in PPHN 230
Upper airway 16
Use of peep 46
V
Variable
extrathoracic obstruction 118
intrathoracic obstruction 118
VELA ventilator 249, 250
Ventilation 17, 35
control 140
for acute respiratory distress syndrom 47, 128
perfusion (V/Q) 228
mismatch 24
strategies 45, 49
Ventilator
causes of patient agitation 70
dependent 147
graphics and clinical applications 107
induced lung injury 202
model AVEA- VIASYS health care 251, 252
waveforms 111
Ventilatory parameters 92
Venturi principle for air entrainment 27
Viasys health care 249
VIP bird ventilator 257
Vital signs 175
Volume
assured pressure support (VAPS) 156
control
descending ramp flow waveform 113
mode 141
rectangle flow waveform 114
rectangle ramp flow waveform 115
rectangular flow waveform with flow 117
rectangular flow waveform 113, 116
sine flow waveform 114
ventilation 40
limited 42
targeted ventilation (SIMV) 125
ventilation 169
ventilators 247
vs time scalar 115
W
Weaning 131, 176, 230
from mechanical ventilation 147
methodology 157
modes 155
Work of breathing (WOB) 110
Z
Zone of perfusion in lung 10
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Chapter Notes

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