The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

SELECTION OF APPROPRIATE VENTILATION PARAMETERS: OUTCOMES ACCORDING TO POPULATION

Kathleen Deakins RRT, Robert L. Chatburn RRT, FAARC, and Timothy R. Myers BS, RRT. Rainbow Babies & Children's Hospital. Cleveland, OH

INTRODUCTION: In disease states requiring mechanical ventilation, the primary goal is to achieve adequate gas exchange while preventing lung tissue damage and minimal disturbances to the cardiovascular system. The Respiratory Care Practitioner (RCP) plays an integral role in the successful management of ventilated patients. Past studies have documented efficiency and ability of RCPs successfully utilizing and implementing weaning protocols on mechanically ventilated patients. The purpose of this study was to describe the ability of our RCPs to initiate mechanical ventilation settings (rate, PEEP, tidal volume, FiO2, inspiratory time, pressure support, pressure limit) and achieve adequate gas exchange by achieving targeted arterial blood gas values in neonatal and pediatric populations.

Methods:
Two hundred two patients admitted to our PICU and NICU were placed on mechanical ventilators during a three-month period (1-8 to 4-8-00). RCPs completed a Mechanical Ventilation Initiation Data Sheet for each patient ventilated. Data collected included age, weight, diagnosis, initial ventilator settings, mode of ventilation and initial blood gas results following ventilation. Enrolled patients that required reintubation were excluded from data recollection. Blood gas values were analyzed separately by pH/ PCO2 for ventilation and PO2/ SaO2 for oxygenation. Ventilation parameters were judged appropriate if the first set of blood gas values were within acceptable ranges. Respiratory alkalosis was defined as pH > 7.45 and PaCO2 < 35 torr. Respiratory acidosis was defined as pH < 7.35 and PaCO2 > 45 torr (for PICU patients, pH < 7.25 for NICU patients). Hypoxic status was defined as PaCO2 < 55 torr (NICU patients) and SaO2 < 93% or SvO2 < 70% (PICU patients).

Results:
The percentage of blood gas results found to be within acceptable ranges are shown in table below. Non-percentage numbers are patients (by location) that did not have acid-base status or oxygenation status measured by blood gas analysis (excluded from the percentage analysis).

Acid-Base Status Overall NICU PICU
alkalotic (n=14) 7% 9% 6%
normal (n =152) 80% 78% 82%
acidotic (n=24) 13% 13% 12%
no gas or capillary gas 12 5 7
Oxygenation Status Overall NICU PICU
hyperoxic (n=27) 15% 35% -
normal (n = 123) 71% 49% 88%
hypoxic (n=24) 14% 16% 12%
no gas or capillary gas 28 21 7

CONCLUSION: In this study, patient population (neonates versus pediatrics) appeared to exert very little influence on therapist ability to initiate mechanical ventilation and achieve adequate gas exchange.

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