Less than 28 weeks
More than 28 weeks
Patient Triggered Ventilation (PVT) or Pressure Control-Assist Contraol(PC-AC)
- Start with valume guarantee. Consider pressure controlled if large leak( >40%)
| SLE 5000 | Drager Babylog |
|---|---|
| PTV with TTV | PC-AC with VG |
| Select TTV | Select Volume Guarantee |
| TIDAL VOLUME-4ml/kg ()Max 8ml/kg in CLD |
TIDAL VOLUME-4ml/kg ()Max 8ml/kg in CLD |
| Set Rate 60 untill good respiratoty effort then set 20 less than baby's own rate | Set Rate 60 untill good respiratoty effort then set 20 less than baby's own rate |
| Max INSPIRARORY TIME 0.3 sec | INSPIRARORY TIME 0.3 sec |
| Trigger 0.2 L/min(adjust as needed) | Trigger 0.2 L/min(adjust as needed) |
| Max PEAK INSPIRATORY PRESSURE 25-30cm H2O(adjust as needed) | PEAK INSPIRATORY PRESSURE 25-30cm H2O(adjust as needed) |
| FIO2 as required | FIO2 as required |
| PTV (pressure limited) | PC-AC |
| Set PIP / PEEP 18 /4 cm H2O(adjust as nedded) | |
| Set Rate 60 (adjust as needed) | |
| Ti 0.3 sec(adjust as needed) | |
| Set Trigger 0.2 L/min(adjust as needed) | |
| FIO2 as required | |
Clinical indication for weaning
- Improment in blood gas
- Reduction in FIO2 < 0.40
- Increase in number of spontaneous breaths
- if over ventilated reduce VT or rate
- in pressure limited mode reduce PIP by 2 cm H2Oeach time untill mean airway pressure < 7
- Extubate to NCPAP when MAP 6-7 cm H2O
- Monitor blood gages within 1-2 hours of ventilator changes
Nasal CPAP
Alternate Methods
Oxygen Index
Fio2:
Mpaw:
Pao2:
Cooling Criteria
Toby cooling criteria
criteria for cooling
All infant that criteria that meet A and B
with in 6 hours of delivery
if infant meets criteria A but not possiable to assess criteria B(e.g After paralyxing agents), cooling should be commenced abd the aEEG should be used to assesee ongoing need.
A. >= 36 completed weeks gestation with at least one of ths following:
- Apgar score of <= at 10 minuts after birth
- Continued need for resuscitatio,including endotracheal or mask ventilation, at 10 minuts after birth
- Acidosis within 60 minuts of birth(cord, arterial or capillary pH < 7.00)
- Base deficit >= 16 mmol/L in umbillical cord or any bllod sample (arterial, venous or capillary) within 60 minuts of birth
B. Seizures (clinical or subclinical*) or moderate tosevere encepnalopathy, consisting of:
- Altered state of consciousness
- Abnormal tone (facal or general hypotonia, or flaccid)
- Abnormal primitive reflexes
- *Subclinical seizures-detected on amplitude intedrated EEG(aEEG)
Cooling Outside Trail Guidelines
Example might inclide:
- infant just lessthan 36 weeks;
- Acute postnatal collapse with a neurological examination consistent eith a diagnosis of acute encephalopathy
Relative Contraindications to Cooling*
- Suspected significant haemorrhage or thrombosis
- A Severe PPHN
- *to discuss the need for colling