From the Guidelines
The recommended ventilation rate for pediatric patients is 20-30 breaths per minute for infants and children, and 30 breaths per minute for neonates, as stated in the 2022 interim guidance to health care providers for basic and advanced cardiac life support in adults, children, and neonates with suspected or confirmed covid-19 1.
Key Considerations
- Ventilation rates vary by age, with neonates requiring higher rates than older children and adolescents.
- The American Heart Association recommends targeting a respiratory rate range of 1 breath every 2 to 3 seconds (20–30 breaths/min) for infants and children with an advanced airway 1.
- A more recent study published in 2024 found an association between ventilatory rate during in-hospital cardiac arrest >12 to 20 breaths per minute and improved outcomes, but this is still a topic of ongoing debate and investigation 1.
Clinical Application
- When performing bag-mask ventilation during resuscitation, the recommended rate is generally 20-30 breaths per minute for most pediatric patients, or 30-60 breaths per minute for neonates.
- For mechanically ventilated children, initial settings typically start within these age-appropriate ranges and are then adjusted based on the patient's condition, blood gas results, and clinical response.
- It's essential to monitor chest rise, oxygen saturation, and end-tidal CO2 to ensure effective ventilation and adjust the ventilation rate accordingly.
Important Notes
- Respiratory rates that are too slow may lead to hypoxemia and respiratory acidosis, while rates that are too fast can cause air trapping, barotrauma, and hemodynamic compromise due to decreased venous return.
- The choice of ventilation rate should be individualized based on the patient's specific needs and clinical condition.
From the Research
Ventilation Rates for Pediatrics
The recommended ventilation rates for pediatric patients vary depending on the specific condition and the patient's age and size.
- Tidal volume: Many pediatric intensivists reported using a tidal volume of 5-8 mL/kg 2
- Positive inspiratory pressure: The upper threshold of positive inspiratory pressure at which intensivists would consider another ventilation mode was 35 cm H2O 2
- Permissive hypercapnia and mild hypoxemia: Many pediatric intensivists considered permissive hypercapnia and mild hypoxemia (SO2 as low as 88%) tolerable 2
Effects of Tidal Volume and PEEP
- Low tidal volume ventilation with PEEP set at 5 cmH2O results in poor oxygenation and compliance in patients with moderate to severe acute lung injury 3
- Reducing tidal volume and increasing positive end-expiratory pressure with constant plateau pressure during one-lung ventilation may reduce oxygenation 4
- The use of a high tidal volume for preventing hypoxemia during one-lung ventilation is controversial, and low tidal volume ventilation with or without PEEP may increase hypoxemia 5
Clinical Judgment in Selection of Tidal Volume
- Guidelines for selection of initial mechanical ventilator settings for pediatric patients are difficult to apply due to various factors such as leaks at uncuffed endotracheal tubes and compression loss in ventilators 6
- A simple, versatile method of teaching selection of initial mechanical ventilator settings, relying on clinical judgment for regulation of tidal volume, may be effective in achieving satisfactory gas exchange 6