Ventilator Modes & Settings
Paediatric ventilation quick reference
Common Ventilation Modes
SIMV (Synchronized Intermittent Mandatory Ventilation)
Delivers set number of mandatory breaths synchronised with patient effort. Patient can breathe spontaneously between mandatory breaths.
PCV (Pressure Control Ventilation)
Pressure-targeted. Set inspiratory pressure, rate, and I:E ratio. Tidal volume varies with compliance.
VCV (Volume Control Ventilation)
Volume-targeted. Set tidal volume and rate. Pressure varies with compliance. Risk of barotrauma if compliance drops.
PS (Pressure Support)
Patient-triggered, pressure-targeted. Augments spontaneous breaths. Used during weaning.
CPAP (Continuous Positive Airway Pressure)
Constant positive pressure throughout breathing cycle. Splints airways, improves FRC. All breaths spontaneous.
HFOV (High Frequency Oscillatory Ventilation)
Supra-physiological frequencies (≥60/min). Low tidal volumes. Active inspiration and expiration. "CPAP with a wobble."
Key Parameters
| Parameter | What It Controls |
|---|---|
| FiO2 | Fraction of inspired oxygen. Adjust for PaO2/SpO2 target. |
| PEEP | Positive End-Expiratory Pressure. Prevents alveolar collapse, improves FRC. |
| PIP / Pinsp | Peak Inspiratory Pressure. Drives tidal volume in pressure modes. |
| Tidal Volume | Target 6-8 mL/kg (lung protective). Monitor in pressure modes. |
| RR | Set respiratory rate. Higher for neonates, lower for older children. |
| I:E Ratio | Inspiratory:Expiratory time. Typically 1:2. Extend expiratory for air trapping. |
Extubation Readiness Checklist
- ☑ FiO2 ≤0.4 with acceptable SpO2
- ☑ PEEP ≤5-6 cmH2O
- ☑ Low pressure support (PS ≤8-10 cmH2O above PEEP)
- ☑ Adequate spontaneous respiratory effort
- ☑ Acceptable blood gases
- ☑ Strong cough and gag reflex
- ☑ Minimal secretions, manageable by patient
- ☑ Sedation weaned sufficiently