logging in or signing up Neonatal Ventilation samarsen Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 2877 Category: Education License: All Rights Reserved Like it (3) Dislike it (0) Added: July 02, 2010 This Presentation is Public Favorites: 4 Presentation Description No description available. Comments Posting comment... By: marwa2001 (8 month(s) ago) please can i download this please, Saving..... Post Reply Close Saving..... Edit Comment Close By: hady1962 (16 month(s) ago) can i download this please Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Basics of Neonatal Ventilation : Dr Sam Sen Specialist Registrar Paediatrics The Royal Oldham Hospital Basics of Neonatal Ventilation Learning Objectives : Learning Objectives Learn about basic Neonatal Anatomy & Physiology in relation to ventilation Learn different modes of mechanical ventilation of neonates History of Ventilation : History of Ventilation Old Testament: –Exodus 1:15-17 -Story of the Hebrew midwife Puah who….“breathed into the baby’s mouth to cause the baby to cry” •Hippocrates ~ 400 BC Described intubation of the trachea to support breathing 1600s onwards Understanding of fundamental laws of gas pressure and volume (Robert Boyle & Robert Hooke) Vital gas –oxygen and its role in respiration –Antoine Lavoisier 1789 Air-pipe intra tracheal ventilation Bellows type ventilation with pressure limiting valves Specific indications for ventilation : Specific indications for ventilation Respiratory distress syndrome (RDS , SDLD) - surfactant deficiency Meconium aspiration Congenital pneumonia Persistent pulmonary hypertension of the newborn (PPHN) Bronchopulmonary dysplasia (BPD) Apnoea Congenital diaphragmatic hernia(CDH) Stages of lung development : Stages of lung development Anatomic & Physiologic Attributes : Anatomic & Physiologic Attributes Prematurity - tissues, organs are not ready for extrauterine life Immature chemoreceptors - prone to apnoea Small, immature lungs Surfactant deficiency -undeveloped alveoli do not function in gas exchange /vulnerability to distention and oxidation injury Anatomic & Physiologic Attributes : Anatomic & Physiologic Attributes Fragile airways - subject to damage from Intubation tracheal, nasogastric, orogastric tubes Suctioning Patient sucking on tubes Anatomic & Physiologic Attributes : Anatomic & Physiologic Attributes Lung compliance is low and changes rapidly - volume monitoring is critical, regardless of target Thoracic compliance is high - minimal skeletal support for lungs Patients will grow - prolonged intubation ==> changing to larger tubes Complications of ventilation : Complications of ventilation Bronchopulmonary dysplasia, due to: mmature, vulnerable lungs inflammation due to ventilator-induced lung injury (VILI) oxygen toxicity oxygen free radicals Complications of ventilation : Complications of ventilation Extraneous air, due to hyperdistension Pulmonary interstitial emphysema Pneumothorax Pneumomediastinum Due to increased mean airway pressure Decreased cardiac output Decreased urinary output Increased intracranial pressure Intraventricular haemorrhage (IVH) Necrotizing Enterocolitis (NEC) Ventilation Modes : Ventilation Modes Noninvasive Ventilation : Noninvasive Ventilation Nasal Nasal continuous positive airway pressure (NCPAP) Nasal positive pressure ventilation (NPPV Synchronized nasal positive pressure ventilation (SNPPV) Synchronized nasal intermittent mandatory ventilation (SNIMV) Noninvasive : Noninvasive Advantages less bronchopulmonary dysplasia less ventilator associated pneumonia Disadvantages limited control over ventilation damage to nasal tissue Invasive Ventilation : Invasive Ventilation Intermittent mandatory ventilation (IMV) Synchronized intermittent mandatory ventilation (SIMV) Assist-control ventilation Pressure support ventilation (PSV) Invasive Ventilation : Invasive Ventilation Advantage greater control over ventilation Disadvantages more bronchopulmonary dysplasia more ventilator associated pneumonia more airway complications from tubes Ventilatory Modes : Ventilatory Modes Mandatory modes Mandatory level of ventilator support Spontaneous respiratory effort in excess of set rate unsupported IMV / CMV SIMV Assist modes Support according to set parameters for all spontaneous respiratory effort Minimum back-up rate in event of apnoea / reduced drive PTV / Assist control Pressure support SIMV : SIMV Set rate determines mandatory breath rate All mandatory breaths fully supported according to set parameters (TCPLV or Volume controlled) Breaths in excess of mandatory rate are supported by bias flow only Weaning on simple SIMV may lead to fatigue due to increased work of breathing from unsupported breaths Controls - typical settings : Controls - typical settings Rate 30 - 60/min PIP 18 - 25 (for TV 5-7 mL/kg) TV 5 - 7 mL / kg BW Insp. Flow 3 - 8 L/min Insp. Time 0.25 - 0.40 sec (for I < E) PEEP 3 - 5 cm H2O (for FIO2 < .6) FIO2 for PO2 = 50- 80 mm Hg; SPO2 = 85-93% Exp. flow trigger - adjust with graphics Pressure support ventilation : Pressure support ventilation Pressure limited Set PIP above baseline PEEP Assist mode (i.e. patient triggered) Demand inspiratory flow Time limit Flow cycled Improves synchronisation with spontaneous respiratory effort Any Questions : Any Questions You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Neonatal Ventilation samarsen Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 2877 Category: Education License: All Rights Reserved Like it (3) Dislike it (0) Added: July 02, 2010 This Presentation is Public Favorites: 4 Presentation Description No description available. Comments Posting comment... By: marwa2001 (8 month(s) ago) please can i download this please, Saving..... Post Reply Close Saving..... Edit Comment Close By: hady1962 (16 month(s) ago) can i download this please Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Basics of Neonatal Ventilation : Dr Sam Sen Specialist Registrar Paediatrics The Royal Oldham Hospital Basics of Neonatal Ventilation Learning Objectives : Learning Objectives Learn about basic Neonatal Anatomy & Physiology in relation to ventilation Learn different modes of mechanical ventilation of neonates History of Ventilation : History of Ventilation Old Testament: –Exodus 1:15-17 -Story of the Hebrew midwife Puah who….“breathed into the baby’s mouth to cause the baby to cry” •Hippocrates ~ 400 BC Described intubation of the trachea to support breathing 1600s onwards Understanding of fundamental laws of gas pressure and volume (Robert Boyle & Robert Hooke) Vital gas –oxygen and its role in respiration –Antoine Lavoisier 1789 Air-pipe intra tracheal ventilation Bellows type ventilation with pressure limiting valves Specific indications for ventilation : Specific indications for ventilation Respiratory distress syndrome (RDS , SDLD) - surfactant deficiency Meconium aspiration Congenital pneumonia Persistent pulmonary hypertension of the newborn (PPHN) Bronchopulmonary dysplasia (BPD) Apnoea Congenital diaphragmatic hernia(CDH) Stages of lung development : Stages of lung development Anatomic & Physiologic Attributes : Anatomic & Physiologic Attributes Prematurity - tissues, organs are not ready for extrauterine life Immature chemoreceptors - prone to apnoea Small, immature lungs Surfactant deficiency -undeveloped alveoli do not function in gas exchange /vulnerability to distention and oxidation injury Anatomic & Physiologic Attributes : Anatomic & Physiologic Attributes Fragile airways - subject to damage from Intubation tracheal, nasogastric, orogastric tubes Suctioning Patient sucking on tubes Anatomic & Physiologic Attributes : Anatomic & Physiologic Attributes Lung compliance is low and changes rapidly - volume monitoring is critical, regardless of target Thoracic compliance is high - minimal skeletal support for lungs Patients will grow - prolonged intubation ==> changing to larger tubes Complications of ventilation : Complications of ventilation Bronchopulmonary dysplasia, due to: mmature, vulnerable lungs inflammation due to ventilator-induced lung injury (VILI) oxygen toxicity oxygen free radicals Complications of ventilation : Complications of ventilation Extraneous air, due to hyperdistension Pulmonary interstitial emphysema Pneumothorax Pneumomediastinum Due to increased mean airway pressure Decreased cardiac output Decreased urinary output Increased intracranial pressure Intraventricular haemorrhage (IVH) Necrotizing Enterocolitis (NEC) Ventilation Modes : Ventilation Modes Noninvasive Ventilation : Noninvasive Ventilation Nasal Nasal continuous positive airway pressure (NCPAP) Nasal positive pressure ventilation (NPPV Synchronized nasal positive pressure ventilation (SNPPV) Synchronized nasal intermittent mandatory ventilation (SNIMV) Noninvasive : Noninvasive Advantages less bronchopulmonary dysplasia less ventilator associated pneumonia Disadvantages limited control over ventilation damage to nasal tissue Invasive Ventilation : Invasive Ventilation Intermittent mandatory ventilation (IMV) Synchronized intermittent mandatory ventilation (SIMV) Assist-control ventilation Pressure support ventilation (PSV) Invasive Ventilation : Invasive Ventilation Advantage greater control over ventilation Disadvantages more bronchopulmonary dysplasia more ventilator associated pneumonia more airway complications from tubes Ventilatory Modes : Ventilatory Modes Mandatory modes Mandatory level of ventilator support Spontaneous respiratory effort in excess of set rate unsupported IMV / CMV SIMV Assist modes Support according to set parameters for all spontaneous respiratory effort Minimum back-up rate in event of apnoea / reduced drive PTV / Assist control Pressure support SIMV : SIMV Set rate determines mandatory breath rate All mandatory breaths fully supported according to set parameters (TCPLV or Volume controlled) Breaths in excess of mandatory rate are supported by bias flow only Weaning on simple SIMV may lead to fatigue due to increased work of breathing from unsupported breaths Controls - typical settings : Controls - typical settings Rate 30 - 60/min PIP 18 - 25 (for TV 5-7 mL/kg) TV 5 - 7 mL / kg BW Insp. Flow 3 - 8 L/min Insp. Time 0.25 - 0.40 sec (for I < E) PEEP 3 - 5 cm H2O (for FIO2 < .6) FIO2 for PO2 = 50- 80 mm Hg; SPO2 = 85-93% Exp. flow trigger - adjust with graphics Pressure support ventilation : Pressure support ventilation Pressure limited Set PIP above baseline PEEP Assist mode (i.e. patient triggered) Demand inspiratory flow Time limit Flow cycled Improves synchronisation with spontaneous respiratory effort Any Questions : Any Questions