Cheatsheet 4

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

Determining Neo and Peds ETT, laryngoscope, and Ideal Tidal Volume: Laryngo Cm @ Cm @ Min Age Weight ETT 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 40 45

30

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 Straight Straight Straight Straight any any Any Any

6.0 – 6.5

3-6 7–8 9 – 10 10 11 12 13 15

9

27.5 35 50 60 70 80 90 100 110 125

38.5 49 70 84 98 102 116 130

150

210

22 - 24 150 175 175 200 200 225

210 245 245 280 280 315

14 17 19

18

Any

6.5

Any

7.0

Any Any Any

Neo VT chart Neo VT chart Neo VT chart

175

1) ETT Size in ID (mm) = 4*(Age/4) 2) Depth oral = Age+13 or 3*ETT size/2 or 6+wt(kg) 3). Tidal Volumes based on pediatric guidelines of 5-7cc/kg ideal body weight 4) For neonates, the NRP suggested guideline for securing 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 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 for Pediatrics: 1. Pt Range: Pediatric (if ideal VT > 40cc<400) 2. Mode: PC if < 10kg, otherwise PRVC 3. VT: 5-7 cc/kg post-term to 14 YO 4. PIP: Not > 30 5. PEEP: Start 4 – 5 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: As 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 certain cases. Consult physician if unable to ventilate at recommended settings. Settings may also be unique to your particular ventilator, or protocols at your particular hospital.