Pediatric Mechanical Ventilation

Question 1

What is a normal ABG for a preterm infant?

Answer 1

> 7.25/45-55/45-65/20-24

Question 2

What is a normal ABG for a term newborn at birth?

Answer 2

7.26-7.29/55/70/20

Question 3

What is a normal ABG for a term newborn after 24 hours?

Answer 3

7.37/33/90/20

Question 4

What is a normal ABG for a infant 1-24 months old?

Answer 4

7.40/35/90/20

Question 5

What are ABG sampling alternatives?

Answer 5

1. Indwelling umbilical arterial catheter
2. Indwelling peripheral artery catheter
3. Arterial puncture
4. Capillary sample
5. Transcutaneous monitoring

Question 6

What is kind of ABG would be targeted in a patient with reduced lung compliance?

Answer 6

1. Permissive hypercarbia
2. Early stage pH of 7.25-7.35
3. Late stage pH of 7.30-7.35

Question 7

What is the SpO2 target for fullterm infants without pulmonary or cardiac disorders?

Answer 7

> 93-95%

Question 8

What ETT size would be used in a 3 kg neonate?

Answer 8

3.0

Question 9

What ETT size would be used in a neonate weighing less than 3 kg?

Answer 9

2.5 or 2.0

Question 10

What ETT size would be used in a neonate weighing more than 3 kg?

Answer 10

3.5

Question 11

What is the formula for determining insertion depth of the ETT?

Answer 11

ETT size x 3 = insertion depth

Question 12

What are the hemodynamic impacts of neonatal intubation?

Answer 12

Apnea
Bradycardia
hypotension

Question 13

What medication can be given during intubation to mitigate the hemodynamic impacts of the procedure?

Answer 13

Atropine = increases HR

Question 14

Where should the tip of the ETT be placed in relation to the carina in neonates?

Answer 14

1-2 cm above the carina

Question 15

What are the initial ventilator settings for neonates?

Answer 15

Mode: Pressure or volume
VT: 4-6 ml/kg
PIP: <28
RR: 20-40
PEEP: 3-5
Itime 0.3-0.7

Question 16

What blade size laryngoscope would you use on a full term neonate?

Answer 16

Blade size 1

Question 17

What are complications associated with intubated neonates?

Answer 17

high risk of extubation
mucus plugging of ETT
Cuff leak
Vocal cord damage

Question 18

What tidal volume should we be targeting in neonates?

Answer 18

4-6 ml/kg

Question 19

What tidal volumes should we be targeting in pediatrics?

Answer 19

6-8 ml/kg

Question 20

How is weaning and extubation different in pediatrics vs adults?

Answer 20

No set standardized guide for extubation readiness is available in pediatrics

Question 21

What are the basic criteria for weaning and extubation in neonates and pediatrics?

Answer 21

1. Resolution of acute respiratory failure or active infection
2. Ability to sustain spontaneous respirations
3. Ability to protect airway