University Hospital of Wales Paediatric Intensive Care Unit Guideline Printed on Wed 23-jul-08
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Last updated March 7, 2019 8:21 AM

0300 0300 789

02920 744622

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029 2184 7322


Noah's Ark Childrens Hospital for Wales
Heath Park
CF14 4XW
02920 747747

Specific ventilation strategies


Defined as acute onset respiratory distress with bilateral pulmonary infiltrates on CXR with a PaO2/FiO2 <200mmHg and no evidence of left atrial hypertension.
Usually secondary to chest or systemic infection, trauma, burns.

tidal volumes 5 - 7ml/kg
high PEEP (10 - 15cm)
tolerate high pCO2 provided pH >7.25
aim for sats 88 - 92%


Maintain pCO2 4.5 - 5kPa (blood gas values, not end tidal) - pCO2 major determinant of cerebral blood flow
In severe refractory intracranial hypertension maintain pCO2 4 - 4.5kPa
pCO2 < 4kPa is associated with cerebral ischaemia - it must be corrected immediately

Pulmonary hypertension

Defined as: pulmonary artery systolic pressure >60% systemic systolic pressure (by echo)
Maintain pH 7.45 - 7.5 ( may use NaHCO3 if necessary) - pH major determinant of pulmonary vascular resistance
Maintain pCO2 normal range
Keep well sedated and consider paralysing
Aim to keep systemic BP high (well filled, dopamine)
Try to keep mean airway pressures low
High FiO2 Only once these measures have failed should iNO be tried.