RSPT 2353 Neonatal/Pediatric Respiratory Care

RSPT 2353 – Neonatal/Pediatric Respiratory Care

Servo 300 Ventilator for use in Pediatrics and Neonates Lecture notes Reference: Whitaker 544-546, Servo 300 Manual

I. Modes and Indications a. Pressure control: provides pressure ventilation with a decelerating flow pattern. . There is a preset Ti, and preset rate. . For patients with uncuffed endotracheal tubes & others for whom variations of lung pressures & high PIP must be avoided. . As with other PC modes patient compliance and RAW will drastically alter the delivered Vt

b. Volume control: provides constant volume ventilation with preset Ve and Vt and rate settings. . This mode is useful for persons with normal lungs who just need some short-term ventilation such as post-op patients. . This mode is comparable to A/C or CMV in other ventilators.

c. Pressure Regulated Volume Control : in this mode, while similar to VC, there is an effort to keep the PIP as low as possible with a decelerated inspiratory flow. . This is adjusted breath by breath. . This is useful for asthmatics, lung injury, during surfactant delivery and in others in whom a high PIP is undesirable. . Max. available peak pressure is 5 cm below that selected as upper pressure limit.

d. Volume Support: the patient triggers each breath creating his own Ve, but if he fails to breathe there is a back up preset Ve to assist. . This mode will also keep the PIP as low as possible. . During periods of apnea, the ventilator reverts to PRVC . Once the patient starts to take over again it returns to Volume Support. . This helps facilitate the weaning process with a back up in case of apnea.

e. SIMV (volume control) + pressure support: is another good weaning mode. . There are mandatory SIMV breaths, and there is constant flow for the mandatory breaths. . PS breathes are triggered by flow or pressure. 2

f. SIMV (pressure control) + pressure support: This mode allows the infant with an uncuffed tube to be on SIMV, . The PS breaths will be triggered by flow or pressure (based on the sensitivity dial selection).

g. Pressure support /CPAP: in this mode the patient can breathe PS breaths or CPAP or a combination of both. . This is a good weaning modality for those who can breath but cannot maintain an adequate Ve.

II. Selecting a Patient Range – The settings affect continuous flow during expiration, max inspiratory peak flow, max measured VT, and apnea alarm time a. Adult: . Continuous flow during expiration: 32 ml/s or 2 L/min . Max inspiratory peak flow: 200 L/min . Max measured VT: 3999 ml . Apnea alarm time: 20 seconds

b. Pediatric: . Continuous flow during expiration: 16 ml/s or 1 L/min . Max inspiratory peak flow: 33 L/min . Max measured VT: 399 ml . Apnea alarm time: 15 sec c. Neonate: . Continuous flow during expiration: 8 ml/sec or 0.5 l/min . Max inspiratory peak flow: 13 l/min . Max measured VT: 39 ml . Apnea alarm time: 10 sec

III. Sensitivity Knob

When the Sensitivity knob is in the green range it is flow triggered – the pt has to inhale a certain part of the continuous flow to get a breath

When the setting is closer to 0 the risk for self-triggering is decreased by it also means the pt has to inhale more of the continuous flow to get a breath.

In the red range, the pt has to only inhale a very small part of the continuous flow to get a breath. The risk for self-triggering is increased.

For pressure triggering, the knob is set between the 0 to –17cmH2O range.

Turning the knob to the right means more sensitive, turning to the left means less sensitive 3

IV. FiO2

 FiO2 is adjusted on the FiO2 knob, there is a safety catch at 60%.

 You have the ability to deliver 100% FiO2 temporarily by activating the oxygen breaths switch. With the same switch you have the ability to deliver manual mechanical breaths.

o 100% FiO2 will only be delivered for 20 breaths or a maximum of 1 minute before returning to the original set FiO2.

V. CMV and Inspiratory Time % Knobs

CMV BPM knob is active in all modes

 In the control modes (PC, VC) it determines the set rate.

 In the synchronized modes it determines the inspiratory time in conjunction with the It% knob:

For example:

At a SIMV rate of 30 bpm, the TCT is 2 seconds

If the CMV knob were placed on 60 bpm, theoretically the TCT would be one second.

If the IT% button was placed on 35%, then 35% of one second is 0.35 sec IT.

Another example: At a SIMV rate of 10 bpm, the TCT is 6 seconds.

If the CMV knob is set at 20 bpm, the theoretical cycle time is 3 seconds.

If the IT% button was set at 35%, and 35% of 3 seconds is 1.05 sec for IT

*The SIMV rate knob sets the rate in these modes.

 In spontaneous modes, the CMV knob determines the breath cycle time and frequency rate.

o The CMV rate and IT must be set to ensure the timing of the safety feature for cessation of pressure support 4

o If the IT should exceed 80% of the cycle, the ventilator will shift in to expiration.

VI. Inspiratory Rise Time %: The rise time % is active in all modes and controls how quickly the pt gets the full preset pressure and flow rate. If the rise time is set to zero, the patient will get all of the pressure and flow rate selected. As the rise time is increased this is dampened. This function is for comfort.

VII. Pressure Control and SIMV (PC) + PS

 “Pressure Control above PEEP” and PEEP equals your set PIP

 PS & PEEP settings should not equal to your set PIP, there is no change in pressure and essentially delivering CPAP. There must be a change in pressures.

VIII. Displays  Pressure: Set and measured pressures are displayed on a digital BAR GRAPH o There are visual numerical read-outs for: . Peak Airway pressure . Mean airway pressure . Pause Pressure . End. Expiratory Pressure

o Airway Pressure bargraph . Upper press. Limit – usually 10-15 cmH2O . Pressure Control Level above PEEP . Pressure Support Level above PEEP . Actual Pressure . PEEP . Trig sensitivity Level below PEEP

o Triggered breaths are indicated by two yellow flashing diodes at the bottom end of the airway pressure bargraph

. Rate (Resp. Pattern): o Measure freq. b/min o Set freq b/min o Insp period s o Insp flow l/s o Volumes: . In Volume mode:  Set Vt 5

 Set Ve  Insp Vt  Exp. Vt  Exp. Minute vol . In pressure mode:  Insp. Vt  Exp. Vt  Exp Ve

. Volume bargraph: Has indicators for  Preset upper alarm limit (Ve)- as indicated for pt  Measured minute volume  Preset minute volume  Preset lower alarm limit (Ve) – as indicated for pt

Just remember….RED in the BED, GREEN on the SCREEN

Highlights Servoi

I. Control a. Additonal modes: SIMV –PRVC; BiVent, noninvasive ventilation with PC or PS ; NAVA (neutrally adjusted ventilation assistance. b. Mode: only Adult or infant II. Alarms a. more customizable