Confirmation

CONFIRM Endotracheal Tube (ETT) placement by:

  • Visualization of end tidal waveform on monitor (may be a delay of 2-3 breaths)
  • Visualization of adequate chest rise with manual breath
  • Presence of condensation in the ETT on exhalation
  • Confirmation of breath sounds on auscultation
  • Obtain chest x- ray
  • Obtain blood gas (capillary/venous blood gas if arterial sample not accessible)
Ventilation Goals

Goals of ventilation should be :

  • Normocarbia (ETCO2/ PaCO2: 35 to 45 mmHg)
  • Saturations >92%
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After Intubation Confirmation
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target mv

References:

Vt: Tidal Volume
RR: Respiratory Rate
Ti: Insipiratory Time
PEEP: Positive End-expiratory Pressure
MV: Minute Ventilation
IBW: Ideal Body Weight
I:E: Inspiratory : Expiratory

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acute hypoxemia on ventilator

BC Children’s Hospital PICU Physicians RT. Acute Ventilation in Pediatrics [Internet]. 2024. Available from: https://www.childhealthbc.ca/file/PICU_Ventilation_Pediatrics 

Maintenance

Ongoing sedation and analgesia: 

  • Morphine 10 to 20 mcg/kg/hour IV
  • Midazolam 100 to 200 mcg/kg/hour IV
  • Dexmedetomidine  0.1-1mcg/kg/hr IV (can be added if available)

Consider ongoing paralytic medications :

  • Rocuronium – intermittent IV boluses of 1mg/kg as required while ensuring adequate sedation