Servo 300/ Servo i

Modes

Use SIMV (pressure control) +pressure support in most situations
Pressure control acceptable for non breathing patients.
Consider using automode on Servo i for post op patients expected to wean
quickly
Consider PRVC for CO2 critical disease eg sick cardiac or brain injury
Check trigger sensitivity set to flow and value is in green range

Settings

PIP: Adjust to give good visible chest movement.
For normal lungs will be around 16 to 20.
Do not use more than 30 without seeking immediate consultant
review
Note tidal volume 10 12 ml/kg for normal lung
6 10 ml/kg for acute lung disease

Volume: As above. NB Servo 300 requires CMV rate and IE ratio (Insp time)
to be set before SIMV rate can be used.

PEEP: 4-5 normally & increase up to 10 vs airway collapse or low
compliance to maintain oxygenation. Discuss with consultant if
PEEP >10 is required.

Insp time: 0.7 to 0.8 for infants
0.8 to 0.9 for young children
0.9 to 1.2 for older children

Rate: 22 to 30 infants
18 to 24 pre school
14 to 20 primary school
10 to 16 adolescent

Decrease rate vs air trapping & airway disease respond to
increased CO2 carefully do not automatically increase rate
Increase rate vs low compliance with CO2 retention

FiO2: lung disease 1.0 initially, decrease to max 0.7, use high PEEP
Cardiac disease discuss oxygenation plan, will depend on cardiac
pathology/ anatomy
General maintain good oxygenation
Always discuss with consultant if continues to require FiO2 >0.7

Alarms: Set all alarms around achieved parameters.
EVITA 4

Modes

Use BIPAP +ASB.
Consider IPPV for CO2 critical disease.

Settings:

PIP: Adjust to give good visible chest movement.
For normal lungs will be around 16 to 20.
Should be less than 30 (discuss if more)
Note tidal volume
10 12 ml/kg for normal lung
6 10 ml/kg for acute lung disease

Volume: As above.

PEEP: 4-5 normally & increase up to 10 vs airway collapse or low
compliance to maintain oxygenation

Insp time: 0.7 to 0.8 for infants
0.8 to 0.9 for young children
0.9 to 1.2 for older children

Rate: 22 to 30 infants
18 to 24 pre school
14 to 20 primary school
10 to 16 adolescent

Decrease rate vs air trapping & airway disease.
Increase rate vs low compliance c CO2 retention.

FiO2: lung disease 1.0 initially, decrease to max 0.7, use high PEEP
Cardiac disease discuss oxygenation plan, will depend on cardiac
pathology/ anatomy
General maintain good oxygenation. FiO2 should be <0.7

Alarms: Essential to set volume alarms.

Babylog

Modes

Use SIMV in almost all situations.
Do not use SIPPV without discussion with consultant. For un-coordinated
breathing try increasing overall support, increasing sedation or using pressure
support (change ventilator).

Settings

PIP: Adjust to give good visible chest movement.
For normal lungs will be around 20.
Should be less than 30 (discuss if more)
Note tidal volume
10 12 ml/kg for normal lung
6 10 ml/kg for acute lung disease

PEEP: 4-5 normally. Increase up to 10vs airway collapse or low
compliance to maintain oxygenation

Insp time: 0.7 to 0.8 for infants
Decrease to minimum 0.6 vs fast rate/ low compliance

Rate: 22 to 30 (depending on size)

FiO2: lung disease 1.0 initially, decrease to max 0.7, use high PEEP
Cardiac disease discuss oxygenation plan, will depend on cardiac
pathology/ anatomy
General maintain good oxygenation. FiO2 should be <0.7

Insp Flow: 10 lpm for neonate. Increase for larger infants, high pressures, fast
rates.

Alarms: Set low minute volume alarm 30% below value associated with
acceptable blood gas.