From the Guidelines
For a 14 kg intubated baby, the recommended tidal volume is 5-8 mL/kg, which equals 70-112 mL per breath, with a target of 5-6 mL/kg often being adequate for many patients. This recommendation is based on the most recent guidance from the American Heart Association, as outlined in the 2022 interim guidance to healthcare providers for basic and advanced cardiac life support in adults, children, and neonates with suspected or confirmed COVID-19 1.
Key Considerations
- Start with a lower volume within this range, such as 5 mL/kg (70 mL), and adjust based on clinical response, chest rise, and blood gas measurements.
- The ventilator should be set to deliver this volume with each mechanical breath, using either pressure or volume control ventilation.
- Monitor peak inspiratory pressures, aiming to keep them below 30 cmH2O to prevent barotrauma, as suggested by the guidelines for ventilator management in intubated patients 1.
- If high pressures are needed to achieve these volumes, consider permissive hypercapnia (allowing slightly elevated CO2 levels) rather than risking lung injury from excessive pressure.
- Regular reassessment is essential as the child's lung compliance may change during treatment.
Ventilator Settings
- Adjust the respiratory rate according to the patient's age and clinical condition, with rates of 20 to 30 breaths/min often used for infants and children.
- Ensure appropriate positive end-expiratory pressure (PEEP) levels to balance lung volumes and venous return, as part of the overall ventilator strategy 1.
- Adjust ventilator settings to deliver full breaths with asynchronous chest compressions if the patient requires cardiopulmonary resuscitation.
From the Research
Tidal Volume Recommendation for Intubated Baby
The recommended tidal volume for an intubated baby can vary depending on several factors, including the baby's weight and the specific medical condition being treated.
- For a 14 kg baby, the recommended tidal volume is not explicitly stated in the provided studies. However, based on the study 2, the median tidal volume measured with a pneumotachometer was 9.5 mL/kg in pressure control mode and 10.2 mL/kg in pressure regulated volume control mode.
- Another study 3 compared tidal volumes in preterm infants before and after intubation, and found that inspiratory and expiratory tidal volumes were significantly larger during mask ventilation compared to endotracheal ventilation.
- A study on mechanical ventilation 4 highlights the importance of optimizing and personalizing ventilation parameters to minimize ventilator-induced lung injury, including adjusting tidal volume, inspiratory stress, dynamic strain, static strain, driving pressure, and mechanical power.
- The study 5 compared the influence of different manual ventilation devices on tidal volume and positive pressure provision in simulated neonatal resuscitation, and found that T-piece devices provided more reliable and constant tidal volumes compared to self-inflating bags.
- A study on emergency department patients at risk for acute respiratory distress syndrome 6 found that initial tidal volumes were higher than recommended, with an average of 1.5 mL/kg above the recommended tidal volume of 6 mL/kg of predicted body weight.
Key Findings
- Tidal volume measurement at the ventilator may not be accurate, particularly in small children 2.
- Upper airway distention during mask ventilation can contribute to tidal volumes measured 3.
- Mechanical ventilation parameters should be optimized and personalized to minimize ventilator-induced lung injury 4.
- T-piece devices provide more reliable and constant tidal volumes compared to self-inflating bags in simulated neonatal resuscitation 5.
- Initial tidal volumes in emergency department patients at risk for acute respiratory distress syndrome were higher than recommended 6.