DID YOU KNOW? - Draeger...DID YOU KNOW? What is it? Volume Guarantee is an option available within...
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VOLUME GUARANTEE IN NEONATAL VENTILATION DID YOU KNOW? What is it? Volume Guarantee is an option available within the patient ‒triggered modes of ventilation available on Draeger neonatal ventilators. How is it applied? When Volume Guarantee is activated, the set tidal volume is reached with a decelerating flow pattern using the following steps: Why is it relevant? • Prevent volutrauma – start VG immediately after birth to minimize the impact of compliance changes • Maintain adequate ventilation at the lowest possible parameters • Maintain stable blood gases • A stable tidal volume avoiding hypocarbia (swings in PaCO2) Why is it helpful to improve the outcome? Inadequate ventilation, instable tidal volume, hypocarbia are proven to lead to injury and inflammation to the lungs and brain in preterm infants already in the delivery room or using HFOV 1,2 . The consequent cerebral blood flow instability could initiate a cerebral inflammatory cascade. This increases the risk of brain injury and potential life-long adverse neurodevelopmental outcomes 3 . Volume guarantee actively works to prevent VT instability, hypocarbia and volutrama. 1. Barton et al, Ventilation-Induced brain Injury in Preterm Neonates: Areciew of Potential Therapies, Neontaology 2016, 110:155-162 2. Wiswell et al, Effects of Hypocarbia on the Develompent of Cystic Periventricular Leukomalacia in Premature Infants Treated with High-Frequency Jet Ventilation, Pediatrics Vol. 97 No. 5 November 1996 3. Barton et al, Unraveling the links between the initiation of ventilation and brain injury in preterm infants – Frontiers in Pediatrics Nocember 2015 Volume 3 Article 97 1. The first breath is a pressure limited breath applying 5 cmH2O above PEEP 2. The proximal flow sensor measures gas flow and tidal volumes returned for each breath 3. The following breaths will increase the peak inspiratory pressure (PIP) up to 75% until the set target tidal volume VT is achieved 4. The PIP increases up to 3 cmH2O as a maximum per breath up to 5 cmH2O below the Pmax alarm setting 5. The lowest PIP delivered is 5 cmH2O above PEEP for non-tirggere and 0.1 cmH2O for triggered breaths 6. The delivered tidal volume cannot exceed 130% of the set VT during the non-triggered breaths which is important during changes in leaks, compliance or respiratory drive PEEP P max P V V T set = 6 mL V T = 8.1 mL V T = 7.3 mL V T = 6.5 mL V T = 6 mL
Transcript of DID YOU KNOW? - Draeger...DID YOU KNOW? What is it? Volume Guarantee is an option available within...
VOLUME GUARANTEE IN NEONATAL VENTILATION
DID YOU KNOW?
What is it?Volume Guarantee is an option available within the patient‒triggered modes of ventilation available on Draeger neonatal ventilators.
How is it applied?When Volume Guarantee is activated, the set tidal volume isreached with a decelerating flow pattern using the following steps:
Why is it relevant?
• Prevent volutrauma – start VG immediately after birth to minimize the impact of compliance changes
• Maintain adequate ventilation at the lowest possible parameters
• Maintain stable blood gases • A stable tidal volume avoiding hypocarbia
(swings in PaCO2)
Why is it helpful to improve the outcome?Inadequate ventilation, instable tidal volume, hypocarbia are proven to lead to injury and inflammation to the lungs and brain in preterm infants already in the delivery room or using HFOV 1,2.The consequent cerebral blood flow instability could initiate a cerebral inflammatory cascade.This increases the risk of brain injury and potential life-long adverse neurodevelopmental outcomes3.Volume guarantee actively works to prevent VT instability, hypocarbia and volutrama.
1. Barton et al, Ventilation-Induced brain Injury in Preterm Neonates: Areciew of Potential Therapies, Neontaology 2016, 110:155-1622. Wiswell et al, Effects of Hypocarbia on the Develompent of Cystic Periventricular Leukomalacia in Premature Infants Treated with High-Frequency Jet Ventilation, Pediatrics Vol. 97 No. 5 November 19963. Barton et al, Unraveling the links between the initiation of ventilation and brain injury in preterm infants – Frontiers in Pediatrics Nocember 2015 Volume 3 Article 97
1. The first breath is a pressure limited breath applying 5 cmH2O above PEEP
2. The proximal flow sensor measures gas flowand tidal volumes returned for each breath
3. The following breaths will increase the peak inspiratory pressure (PIP) up to 75% untilthe set target tidal volume VT is achieved
4. The PIP increases up to 3 cmH2O as a maximum per breath up to 5 cmH2O belowthe Pmax alarm setting
5. The lowest PIP delivered is 5 cmH2O above PEEP for non-tirggere and 0.1 cmH2O for triggered breaths
6. The delivered tidal volume cannot exceed130% of the set VT during the non-triggered breaths which is important during changes in leaks, compliance or respiratory drive
PEEP
Pmax
P
V
VT set = 6 mLVT = 8.1 mL VT = 7.3 mL VT = 6.5 mL VT = 6 mL
