NIMV settings question

PeakRN · Nov 17, 2017

If you have an order that isn't clear or doesn't make sense you should be clarifying it with the provider.

itsybitsy · Nov 18, 2017

Agree with above. But I would interpret the order as 14 over the PEEP which would equal the PIP. So if your PEEP is 5, the settings would be 19/5. What's off-putting is the use of PC. The only thing I can think of that would be PC is pressure control as in pressure support. Which would not have anything to do with the PEEP because it is based solely on the extra pressure provided for the babies own initiated breaths. In this case, 19/5 would be what pressures the ventilator is giving on ventilator initiated breaths. Plus, a pressure support of 14 is really high and I would question whether NIMV is even appropriate if they want/the baby needs the pressure support that high.

Julius Seizure · Nov 25, 2017

I would read this as a pressure control of 14, and a peep of 5. If there was also a pressure support setting ordered, it couldn't be any higher than 9 because 5+9 = 14. Note that pressure control is not the same as pressure support. Pressure control of 14 means that the pressure is not allowed to go over 14, no matter what the baby does. Pressure support of 14 means that the ventilator gives additional support to give a higher pressure than the baby might do on their own.

(There doesn't HAVE to be a PS ordered specifically, so don't be confused if you just seen PC and PEEP in the order.)

itsybitsy · Dec 2, 2017

I would read this as a pressure control of 14, and a peep of 5. If there was also a pressure support setting ordered, it couldn't be any higher than 9 because 5+9 = 14. Note that pressure control is not the same as pressure support. Pressure control of 14 means that the pressure is not allowed to go over 14, no matter what the baby does. Pressure support of 14 means that the ventilator gives additional support to give a higher pressure than the baby might do on their own.
(There doesn't HAVE to be a PS ordered specifically, so don't be confused if you just seen PC and PEEP in the order.)

Correct me if I'm wrong but pressure control doesn't mean the PIP can't go any higher than the set pressure support + PEEP. This is what I interpret what you are saying...

The PIP can go higher than PS + PEEP. If you just watch the ventilator, every breath reads a different ultimate PIP and if you have PS of 9, with a PEEP of 5, you can see PIPs higher than 14, when the baby initiates their own breaths. Usually it's only 1 or 2 higher as in 15 or 16, but it doesn't cut off at 14. The same is true for volume guarantee, except there is a pmax. Which is around 25 for most settings.

Plus, a pressure control of 14 wouldn't really do any baby justice. You would be under-inflating the lungs and not giving adequate breaths.

itsybitsy · Dec 2, 2017

I might add to my statement that if a PIP is higher than the PS + PEEP, it may read that because the baby took a larger breath. The ventilator wouldn't give the baby a higher PIP, only the baby would be able to do that on its own.