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Guide to Neonatal Ventilation Case Study 2

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Case Study 2: Assist/Control (A/C) Ventilation
  • Baby Jason is a 25 0/7-week male infant who is DOL 31 (post-menstrual age: 29 2/7 weeks). He remains intubated on mechanical ventilation since his day of birth (DOB) with the current diagnosis of chronic lung disease/BPD; status post (s/p) severe RDS. His current settings are; SIMV volume targeted ventilation with a target of 5 mL/kg, PEEP of 6 cm H2O, Rate of 30 breaths/minute, Ti 0.4 seconds. Jason has been noted to be more tachypneic and restless with increasing CO2 above 60 mmHg. The medical team would like to avoid sedation at this time. The decision is made to switch Jason to A/C ventilation. His ventilator settings are changed to: assist/control with minimum backup rate of 35 breaths/minute; PEEP 6 cm H2O; Ti 0.4 seconds; volume target 5 mL/kg.

  • Questions
    1. What are the basic principles of assist/control ventilation?
    2. What are the benefits and limitations of A/C ventilation?
    3. Based on the above scenario what would be the rationale for choosing A/C ventilation for Jason at this time? 
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  • About the Contributor

    AnnMarie Barber, MS, MSN, CRNP, is an NNP with over 19 years of experience practicing in the Philadelphia area. She received her BSN and Masters in Human Organization Science degrees from Villanova University and her MSN degree from the University of Pennsylvania. Since 2013 she has been a Clinical Nurse Educator for Mallinckrodt Pharmaceuticals providing expert consultation and education to neonatal clinicians regarding the diagnosis and treatment of PPHN and the utilization of inhaled nitric oxide. She has also been a speaker at several conferences and clinical meetings including the Virginia Society of Respiratory Care Conference, the Robert Wood Johnson University Respiratory Conference, and ANN's 16th National Neonatal Nurses Conference. She served on ANN's Executive Committee from 2014 to 2016.

     

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