From the Guidelines
For a 13-year-old male child requiring mechanical ventilation, I recommend starting with a tidal volume of 5-8 ml/kg of ideal body weight, respiratory rate of 16-20 breaths per minute, PEEP of 5 cmH2O, and FiO2 of 40% initially, titrating down to maintain SpO2 >92%. These settings should be adjusted based on the child's specific condition and arterial blood gas results. The most recent and highest quality study 1 supports the use of low tidal volumes (4–8 ml/kg predicted body weight) and target plateau pressure <30 cmH2O.
Key Considerations
- Tidal volume: 5-8 ml/kg of ideal body weight, as recommended by 1
- Respiratory rate: 16-20 breaths per minute, as a general guideline for pediatric patients
- PEEP: 5 cmH2O, as a starting point for pediatric patients
- FiO2: 40% initially, titrating down to maintain SpO2 >92%, as recommended by 1
- Plateau pressure: aim <30 cmH2O, as recommended by 1
Ventilator Settings
- Inspiratory pressure: 15-20 cmH2O above PEEP, as a general guideline for pressure-controlled ventilation
- Inspiratory time: approximately 0.8-1.0 seconds, with an I:E ratio of 1:2, as a general guideline for pediatric patients
- Sedation and analgesia: may be required for patient comfort and ventilator synchrony, with midazolam (0.05-0.1 mg/kg/hr) and fentanyl (1-2 mcg/kg/hr) as options, as recommended by 1
Monitoring and Adjustments
- Regular assessment of ventilator parameters, including plateau pressure, driving pressure, and compliance, is essential to ensure adequate gas exchange and minimize volutrauma and barotrauma, as recommended by 1
- Adjustments to ventilator settings should be made based on the child's specific condition and arterial blood gas results, as recommended by 1
From the Research
Ventilatory Settings for a 13-Year-Old Male Child
There are no specific studies provided that directly address the ventilatory settings for a 13-year-old male child. However, we can look at general guidelines and settings used in various studies:
- General Ventilatory Settings:
- A study on extracorporeal membrane lung oxygenation 2 suggests a decrease in fraction of inspired oxygen, a consistent decrease in tidal volume, no change in positive end-expiratory pressure, and a moderate decrease in respiratory rate.
- A "six-dial strategy" for mechanical ventilation during cardiopulmonary resuscitation 3 recommends settings such as positive end-expiratory pressure of 0 cm of water, tidal volume of 8 mL/kg, fraction of inspired oxygen at 100%, respiratory rate of 10 per minute, and maximum peak inspiratory pressure of 60 cm of water.
- Positive End-Expiratory Pressure (PEEP) and Fraction of Inspired Oxygen (FIO2) Settings:
- An oxygenation advisor study 4 recommends appropriate combinations of PEEP and FIO2 to achieve and maintain pulse oximeter oxygen saturation between 88% and 95%.
- A study on the effect of PEEP on lung injury 5 suggests that setting PEEP 2 cm H2O above the lower inflection point on the inflation pressure-volume curve results in the least injury.
- Other Considerations:
- A study on the effect of pressure support ventilation and PEEP on the rapid shallow breathing index 6 found that the use of pressure support ventilation and/or PEEP can influence the rapid shallow breathing index, while changes in FIO2 may have no effect.
These studies provide general information on ventilatory settings, but it is essential to consult with a healthcare professional to determine the best settings for a specific patient, as individual needs may vary.