Cheatsheet 4

Respiratory Therapy Cave Respiratorytherapycave.blogspot.com  Neonatal and Pediatric Guidelines and Calculators

Determining Neo and Peds ETT, laryngoscope, and Ideal Tidal Volume: Volume: Laryngo Ag e Weight ETT Cm @ Cm @ Min Max scope (kg) lipline  Nasal VT VT Premature Premature Term 3 months 6 months 1 years 2 years 3 years 4 years 5 years 6–7 years 8 – 10 years

0.5 – 1 1. – 2 3 .0 5. 5 7 10 12 14 16 18 20 22 25

10 – 12 years 12 – 14 years

30 35 35 40

30

40 45

2. 5 2.5 – 3.0 3.0 – 3.5 3.5 – 4.0 3.5 – 4.0 4.0 – 4.5 4.5 – 5.0 5 .0 5 .5 5 .5 6.0

Straight Straight Straight

3-6 7–8 9 – 10

 Neo VT chart

9

 Neo VT chart

Straight Straight Straight Straight any

27.5 35 50 60 70 80 90 100 110 125

38.5 49 70 84 98 102 116 130

150

210

22 - 24 150 175 175 200

210 245 245 280

200 225

280 315

10 11 12 13

17

15

19

14

any Any Any

6.0 – 6.5

18

Any

6.5

Any

7.0

Any

 Neo VT chart

Any Any

175

1) ETT Size in ID (mm) = 4*(Age/4) 4*(Age/4) 2) Depth oral = Age+13 or 3*ETT size/2 or 6+wt(kg) 3). Tidal Volumes Volumes based on pediatric guidelines of 5-7cc/kg ideal body weight 4) For neonates, the NRP suggested suggested guideline for securing the the ETT is weight in kg = 6 (2kg+6 = 9cm at lip)

 Normal Pediatric Respiratory Rate and Heart Rate Kg Asleep Awake HR RR  RR  0-1 day 30-40 94-145 1-7 day 30-40 120-160 8-30 day 30-40 115-190 Infant to =<4 30-40 40-70 120-130 1 month Infant to =<7 22-30 55-75 130 6 month 1 year =<10 16-24 25-42 120 2-3 years 12-14 14-26 20-36 115-125 4-5 years 16-18 16-20 18-32 100-110 6-8 years 20-26 12-16 16-30 90-100 10-12 32-42 12-25 75-85 >14years >50 12-18 70-100 respiratorytherapycave.blogspot.com 09/07/2009

Severe Distress

RR>60 RR>50 RR>40 RR>40 RR>35 RR>30

Setting up CPAP for a neonate: 1. 5–6 CWP good place to start 2. 7 – 8 CWP if FiO2 needs >60%, or signs increased SOB 3. If SpO2 > target range, down FiO2 by 5–20, then allow 4 minutes for stabilization between each change. 4. If SpO2 < target range, up FiO2 by 5–20, then wait 4 min for stabilizing between changes 5. Continue assuring AW AW patent, HR > 100, & infant not apneic. Suspected PPHN: - Target SpO2 = 96 – 99% - Do pre and post-ductal SpO2s - Pre-ductal: SpO2 = right arm ABG = R. Radial - Post-ductal: SpO2 = feet ABG = umb.artery - If PO2 difference >15mmHg= R to L shunt of Ductus ateriosis Suspected cyanotic heart disease: - Consider 100% O2 challenge - If no response in pt. with no respiratory distress, transfer pt.

Guidelines for Set-up of ventilator ven tilator for Pediatrics: 1. Pt Range: Pediatric Pediatric (if ideal ideal VT > 40cc<400) 2. Mode: PC if < 10kg, otherwise otherwise PRVC PRVC 3. VT: 5-7 cc/kg post-term to 14 YO 4. PIP: Not > 30 5. PEEP: Start 4 – 5 CWP CWP 6. FiO2: 5 – 10% above pre-intubation adjust to maintain desired SpO2. 7. Rate: Normal for age 8. I-time: a. Maintain I:E of 1:2 9. I-Rise time: time: As appropriate appropriate for patient to create pseudo sign wave. 10. PIP limit: 2-3 >PIP (other alarms as appropriate) Higher PIP & VT may be needed in in certain cases. Consult physician if  unable to ventilate at recommended recommended settings. Settings may also be unique to your particular ventilator, or protocols at your particular hospital.