Mechanical Ventilation Parameters for 1-Month-Old Infants

Maximum Pressure Parameters

For a 1-month-old infant on mechanical ventilation, the maximum inspiratory pressure should be kept ≤28 cmH2O for healthy lungs, ≤29-32 cmH2O with increased chest wall elastance, and ≤30 cmH2O in obstructive airway disease 1, 2, 3
Maximum PIP should be kept ≤28 cmH2O for infants with healthy lungs 1
For infants with increased chest wall elastance, PIP can be increased to ≤29-32 cmH2O 3
In obstructive airway disease, PIP should be kept ≤30 cmH2O 4
If pressure is being monitored during initial ventilation, an initial inflation pressure of 20 cmH2O may be effective in preterm infants, but pressures of 30-40 cmH2O may occasionally be necessary in term infants 5, 6

Standard PEEP for infants should be 5-8 cmH2O 1, 3
Higher PEEP may be necessary depending on underlying disease severity (including in cardiac patients) 3, 4
For healthy lungs, PEEP should be kept ≤10 cmH2O 1, 2
PEEP titration and lung recruitment should be considered based on disease condition 3
In obstructive airway disease, additional PEEP may be needed when there is air-trapping to facilitate triggering 4
High levels of PEEP (8-12 cmH2O) may reduce pulmonary blood flow and increase risk of pneumothorax 6, 8

Measure peak inspiratory pressure, plateau pressure, mean airway pressure, and PEEP 1
Monitor pressure-time and flow-time scalars to assess patient-ventilator interaction 3
Measure flow near the Y-piece of the patient circuit for children <10 kg to improve trigger sensitivity 1
Target patient-ventilator synchrony as a primary goal during ventilation 3
Set the inspiratory trigger sensitivity at 0.5-0.6 L/min to optimize patient-ventilator synchrony while avoiding auto-triggering 7

Using unnecessarily high pressures when lower pressures would achieve adequate ventilation 5
Failing to adjust PEEP based on underlying disease condition 3
Setting inappropriate trigger sensitivity that can increase work of breathing or cause auto-triggering 7
Failing to monitor for patient-ventilator asynchrony, which can increase work of breathing 7