1. Ventilation strategies
We’ll just talk about basic strategies. Feel free to ask questions, if you are not sure about anything.
Dr R Mathur

2. Learning objectives To know basics of ventilation
When to ventilate / when not to ventilate
What to do when patient deteriorates
Troubleshooting
Complications of ventilation
How to use ventilators

3. Common terms O2 = Oxygen (Fi O2) Rate PIP PEEP IT MAP
Frequency, Delta P etc.
We’ll discuss various modes later.

4. Pressure time curve

6. Types of ventilation
Volume ventilation: Volume is constant and pressure will vary with patient’s lung compliance.
Pressure ventilation: Pressure is constant and volume will vary with patient’s lung compliance.

12. Indications of ventilation
RDS
MAS
GBS pneumonia
HIE
PPHN
Sepsis
Head injury
Asthma
Bronchiolitis ?

13. Modes of ventilation
High flow
CPAP
SIMV
CMV
PSV / PTV
HFOV

14. Setting a ventilator Connect to electricity Connect gases
Connect the circuit
Fill in water in Humidifier (specially in HFOV)
Set Rate,FiO2, PIP, PEEP, IT, Flow rate, alarms
Test lung
Check that it’s working before connecting to baby!

15. Troubleshooting Ventilation problem Oxygenation problem
CO2 clearance problem
Patient not settled
Alarms

16. Patient desaturating What do you do next?
Check ventilator settings
Connections
Tube in correct position
Pneumothorax

18. Oxygenation problem – what’ll you change first?
PEEP
?Rate
PIP IT
Mode?

19. CO2 clearance issues
Rate
PIP
PEEP IT
Mode?
HFOV
? Paralyse

20. Initial settings 1 kg 28 week Respiratory Distress Syndrome
– To be intubated & given Surfactant
Rate
FiO2
PIP
PEEP IT
What next??

21. Bigger baby Term,4 kg, MAS, Sats 75% in air at 30 min age Rate FiO2
PIP
PEEP IT
? S
? NO

22. 10 year old Status Epilepticus – Previously fit & well.
Settings
Rate
FiO2
PIP
PEEP IT
What next??

23. Summary of what you’ve learnt today
Basics of ventilation
When to ventilate
How to connect ventilator to patient
What helps oxygenation most effectively
What needs to be done to clear CO2
How to troubleshoot
When to extubate

24. Any questions???