Where can I get good info on respiratory?

SteveNNP, MSN, NP · Jan 10, 2007

I don't know of any books offhand, I learned everything I know about neonatal ventilation by pestering our RT's with questions as we teamed up to assess/reposition our assigned babies, aske the neos, and go over all the ABG stuff they drilled into us in school.....as far as basic info, maybe this will help:

PIP- (peak inspiratory pressure) maximum pressure in mmHg attained during inspiration

PEEP - (positive end-expiratory pressure) the vent uses a set pressure to "hold" the airspaces open in between breaths.

PS- (pressure support) the vent "adds" a set amount of pressure with each breath to increase expansion/ventilation.

TI- (time of inspiration) or ("I-Time") similar to the insp:exp ratio on adults. The vent gives an inspiratory breath over a shorter period than the expiratory period. (0.33 = 1:3, 0.4 = 1:2.5, etc...)

SIMV- (synchronized intermittent mandatory ventilation) the vent gives a set # of breaths per min at a set pressure, but synchronizes with the infant's own efforts. In essence, it "counts" and assists the infants own breaths toward that total.

PC- (pressure control ventilation) The vent assists with EVERY breath triggered by the infant to regularly deliver a set of pressures with a backup rate. Basically assist/control mode in adults but with a set pressure instead of a tidal volume.

Now for HFOV:

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MAP- mean airway pressure- the vent holds the airways open at a constant airway pressure. You increase the MAP to increase oxygenation.

Amps- (amplitude) Basically the amount of chest "wiggle" or tidal volume. You increase this to blow off more Co2, decrease to retain CO2. This decreases when you increase the Hz.

Hz- (hertz) Basically the respiratory rate. I believe you multiply the hz x 300 to get the actual "RR." Now this one is tricky.... you decrease the hz (RR) to deliver a greater minute volume and blow off more Co2, and you INCREASE the hz to increase the RR and DECREASE the MV to retain more co2.

** the way this works involves thinking of how the oscillator works. It's basically a piston sliding back and forth at a fast rate against a diaphragm. By increasing the Hz (rate) the piston has to spend more time speeding up and slowing down as it goes from one end of the chamber to the other at a faster rate. This actually decreases the total tidal volume delivered, which is inversely true when the piston moves at a slower speed (lower Hz), has more time to speed up/slow down, and delivers a larger TV, blowing off more Co2)**

TI- is the same for conventional vents.

So to increase oxygenation: increase MAP and Fi02

To lower the infant's CO2 (resp acidosis), increase the amps and/or decrease the hz (opposite for resp alkalosis)

I hope this isn't too confusing.... I really enjoy the respiratory part of NICU. We use a lot of HFOV, and use SERVOi vents, which are great. We're getting our Vapotherms back soon!!!! YAY!!!

danissa, LPN, LVN · Jan 10, 2007

SteveRN21--great descriptions of respiratory terminology, especially for newbies! Well Done You! Wish I could explain it to my students so well! :lol2:

Rockhound · Oct 6, 2007

I have a Question please Help ME!!!

The place I work is now requiring LVN's to do respiratory on ventilator patients. They say the RT's will be available for weaning but the LVN's will do treatments, trach care etc. That is fine with me but I don't feel comfortable with adjusting vent settings etc. Is this even within my scope of practice for LVN. When I was in school my instructors basically said if the alarm is going off check tubes etc but the RT's handle the settings. Help.

RainDreamer, BSN, RN · Oct 7, 2007

I have a Question please Help ME!!!
The place I work is now requiring LVN's to do respiratory on ventilator patients. They say the RT's will be available for weaning but the LVN's will do treatments, trach care etc. That is fine with me but I don't feel comfortable with adjusting vent settings etc. Is this even within my scope of practice for LVN. When I was in school my instructors basically said if the alarm is going off check tubes etc but the RT's handle the settings. Help.

I don't know, in our unit, as RNs, we never even TOUCH the vent settings. We just make sure all the settings are correct and we can increase/decrease the FIO2 as needed, but when we have any sort of vent change, the RT has to do it.

elizabells, BSN, RN · Oct 8, 2007

On our unit when a baby is on a standard vent (AC, CMV, SIMV) RNs can change the FiO2, rate, and pressures, although some don't feel comfortable and call RT for anything other than FiO2 changes. We do not touch the oscillator except for FiO2, and we don't change iNO levels. The RTs on our unit do very little compared to other units. They just set up vents and help move intubated babies - we do all nebulizers, suctioning, etc. Oh, they do iStat ABGs as well, but usually only on the fresh post-op cardiac babies. We only have one LVN, and she works more as support staff - virtually no patient care.

SteveNNP, MSN, NP · Oct 8, 2007

Yeah, units are really different in terms of respiratory management and what RNs do in terms of making vent changes. At my last job, the RT's made all changes other than Fio2 adjustments, and did most of the suctioning and treatments. It is beneficial to know how to make changes based on the baby's ABG, though. This way you can anticipate what to do next if the kid is acidotic, or needs his rate changed ASAP, etc. One of the reasons I decided to go back to school was to learn the "How's" and "Why's" of the things we do in NICU. Too often we just blindly follow orders without knowing why we're doing it.

elizabells, BSN, RN · Oct 8, 2007

It is beneficial to know how to make changes based on the baby's ABG, though. This way you can anticipate what to do next if the kid is acidotic, or needs his rate changed ASAP, etc.

That's a really good point, Steve. Recently I had a provider who was so exhausted at 0430 that she told me to make a vent change that was the opposite of what the ABG would have indicated. If I hadn't known that low pCO2 ---> decrease the rate, that would have been bad.

RainDreamer, BSN, RN · Oct 8, 2007

That's a really good point, Steve. Recently I had a provider who was so exhausted at 0430 that she told me to make a vent change that was the opposite of what the ABG would have indicated. If I hadn't known that low pCO2 ---> decrease the rate, that would have been bad.

Oh yeah, that happens quite often with the residents!! It's like "maybe you should re-think that!"

SteveNNP, MSN, NP · Oct 9, 2007

Oh yeah, that happens quite often with the residents!! It's like "maybe you should re-think that!"

Yeah... I'm running out of nice ways to suggest what I really want... like: "Hmmm...how do you feel about decreasing the rate to 25?" as opposed to me saying: No, we need to change the rate to 25.:trout:

I feel bad for the poor residents. They have to act like they know what the H#ll they're doing in the NICU. At least some of them are humble enough to admit you're right and they have no idea.

elizabells, BSN, RN · Oct 9, 2007

Oh yeah, that happens quite often with the residents!! It's like "maybe you should re-think that!"

Hee, yeah. I had actually hung up the phone already and went - "wait. No." So I asked one of the other nurses just to make sure I wasn't totally nuts or in Bizarro Land, and then I called her back, all "Just wanted to make sure I heard you right..." She actually thanked me later, which was nice.