![]() With each breath the ventilator delivers a decelerating breath over the set time at an inspiratory pressure within the allowed range. The final commonly used mode for ventilating pediatric lungs is PRVC which, rather than requiring a set inspiratory flow rate like most volume controlled modes, utilizes a set inspiratory time, a targeted tidal volume, and a range of allowed pressures. This means that worsening compliance results in higher airway pressures (Table 1). The ventilator delivers a fixed flow of air until the desired tidal volume is reached. In contrast, VCV ventilation requires that the physician set the inspiratory rate, inspiratory flow rate, tidal volume, and PEEP. This means that worsening compliance results in low tidal volumes. When utilizing PCV, the provider sets the, inspiratory rate, inspiratory time, and inspiratory pressure meaning that the delivered tidal volume is dependent on the lung compliance of the patient. PCV is typically favored in neonates and infants while volume modes are preferred in larger children. The most commonly used modes for emergency pediatric ventilation include pressure assist control ventilation (PCV), volume control ventilation (VCV), and pressure regulated volume control ventilation (PRVC). Although the use of a Broselow tape and other height based methods of estimating body weight for drug dosing is fraught with error 5, the Broselow’s color coding allows for quick estimation of ideal body weight (IBW) that is required to calculate ideal tidal volumes.Īs mentioned, practice patterns related to pediatric ventilator management vary greatly. Like the Fat Man said in House of God: “ comes first.” The intubated child is bound for a pediatric ICU and hopefully the accepting pediatric intensivist is already aware of any intubated patient and can be a great deal of help and support as you work together to make your patient safe for transfer upstairs or across town. By keeping in mind small differences in pediatric physiology and keeping the consulting intensivist (and Broselow Tape) close at hand, an EP can effectively initiate mechanical ventilation in the smallest and most anxiety-provoking patients. However, pediatric ventilator management is largely driven by data extrapolated from adults, which should come as a relief to the EP. These unknowns can make the prospect of managing these patients even more intimidating. Additionally, evidence driven practice in pediatric mechanical ventilation is limited and practice patterns vary between institutions and providers. Hence, it stands to reason that EP experience with mechanically ventilated children can be scarce. ![]() Children are intubated three to six times less often than adult emergency department patients. Airway management of pediatric patients is a reasonable source of anxiety for the emergency physician. ![]()
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