PNRC 06 Flashcards
What are the two protocols for surfactant replacement?
prophylactic and therapeutic
If a patient receives surfactant, what is the most important thing to monitor?
TV
If surfactant administration is given to the patient and it was working well, what two things would have significant changes?
they should have a marked improvement in oxygenation and compliance
values that indicate the need for CPAP
RR >30% of normal
s/s of cyanosis with FiO2>50%
Paradoxical chest movement
Recurrent apnea
How do you know when the pt is failing on CPAP and when they need to move to mech ventilation
PaCO2 > 60
pH <7.25
High FiO2 and CPAP (10 or more)
term infant
38-42 week
PaO2 values for PPHN pre term and term
60-80 term
50-80 pre term
80-100 for PPHN
6 indications for MV (mechanical vent)
improve oxygenation
stabilize chest wall
Normal birth weight
2.7-3.9kg
Weight to be determined premature or SGA
Anything less than 2500g
What are the 7 things you can change to improve oxygenation in PCV
i time, I:E, PiP, PEEP, MAP, FiO2, and rate
What are the FiO2, RR, PiP, Flow, and TV for pt with RDS
FiO2 of 40% for SpO2 90-92% RR 30-60 PiP 15-25 Flow 4-8 TV 4-6
Normal infant ABG
ph 7.3
CO2 40-50
PaO2 60-80 (term)
How do you fix asynchrony in volume ventilation vs pressure ventilation?
Flow in volume ventilation and rise in pressure ventilation
CO2 value and SpO2 value that would indicate successful CPAP treatment
SpO2 88-95%
PaCO2 < 60 with normal pH
What is the most commonly used CPAP interface
CPAP prongs
Sizing choice for RAM cannula
Should occlude 60-80% of the nares, if it is above 80% you would want to choose a size SMALLER and vice versa
How to place the bevel in RAM cannula
place facing down
Most common way children are mechanically ventilated
In volume ventilation or volume targeted
What is the first step when weaning CPAP
You want to decrease the FiO2 to <30%
**Wean in very small increments to avoid the flip flop phenomenon
After weaning down the FiO2 in CPAP, what do you want to decrease next?
You want to decrease the pressure next. In increments of 1-2 until goal of 3-5cmH2O is obtained
When using bubble CPAP, what are reasons that you would no longer hear bubbling?
connections could be loose, prongs not fitting well, or crying
**Prevent: Offer pacifier to avoid crying and check all tubing conections
NPPV interfaces for ages less than two compared tochildren?
RAM cannula for kids up to 2 years old. Masks are most common in older children
**Masks cause high risk for aspiration
Purpose of NVVP in neuro patients
Helps improve quality of sleep
Purpose of NPPV in CF pt
Won’t improve lung function but will help with gas exchange during an acute illness or waiting for a lung transplant.
What is the most common type of NPPV used in peds pt
Bilevel Mode (Spontaneous/Timed)
Initial IPAP EPAP settings
IPAP- 8-12
EPAP- 5-8
If you have a pt with a high CO2 what would you change in IPAP EPAP settings?
Decrease the IPAP in order to decrease the PS which would decrease their ventilation rate
PaCO2 value requiring mechanical ventilation
> 60
PaO2 value requiring mechanical ventilation
1 <50 on FiO2 80
2 sats are 88% or less on FiO2 80%
pH requiring mechanical ventilation
<7.20
Most common type of mechanical ventilation in infants
TCPL
Most common way children are mechanically ventilated
In volume ventilation or volume targeted
Flow difference between TCPL vs PCV
Flow is constant throughout the cycle while in PCV the pressure is constant but the flow is variable
In pressure control, what is very difficult to truly measure?
Cannot obtain a true static or dynamic compliance.
Not being able to set a preset TV causes this issue
Flow sensors are placed where?
between the ETT and the “Y” of the circuit
What purpose do flow sensors provide?
It is more responsive, allowing the pt to trigger breaths much easier and breathe more comfortably
ventilatory rate for extubation criteria
5-10
Most important alarm in PC
Low and high tidal volume alarms
i time for initial setting
.4-.7 seconds
**LBW 0.25-0.4
In PC when do you adjust the rise?
Too long or fast reaching the Pip
