Guidelines for setting up Servo 300A as a Neonatal Ventilator:

1. Pt range: Neonate (Maximum VT = 40cc)

2. Mode: Pressure Control (works best for un-cuffed ETT)
3. VT: a. <33 weeks gestation 4 – 6 cc/kg
b. >33 weeks gestation or chronic 5 – 7 cc/kg
4. PIP: a. Maximum PIP settings:
- <27 weeks gestation 24 CWP
- 27 – 32 weeks gestation 26 CWP
- 33 – 40 weeks gestation 28 CWP
b. Start low (best to err on low side to prevent barotraumas.)
c. Increase to obtain target VT and adequate chest rise
d. Frequently monitor & adjust PIP to accommodate
changes in lung compliance altering tidal volume.
5. PEEP: a. Start at minimum 4 – 5 CWP
b. Increase to 6 – 7 CWP if FiO2 needs > 60%
c. Adjust to maintain acceptable PaO2 and SpO2
d. 8 – 10 CWP PEEP if directed by physician
e. Remember that PC setting is “above PEEP”
6. FiO2: a. Start low at 40%
b. Adjust to maintain target SpO2
c. If SaO2 < target range, FiO2 may be increased by 2–5,
& then allowing 4 minutes for stabilization after each
change. (consider adjustment of PIP and PEEP also.)
d. Continue assuring AW patent, HR>100 & baby not apneic.
e. If SaO2 > target range, FiO2 may be decreased by 2 – 5,
allowing 4 minutes for stabilization after each change.
f. Consider increasing PEEP prior to FiO2
g. Maintain neonate on ROOM AIR whenever possible.
7. Rate: a. 50 – 60 if < 34 weeks gestation or < 3 kg
b. 40 – 50 if >34 weeks gestation or > 3 kg
c. 30 – 40 if 40 weeks gestation; slightly higher if indicated.
d. Watch for air trapping at rates > 40 (adjust I-time).
8. I-time: a. Start at 0.3 plus or minus 0.5 (post-term may need more.)
b. Neonatal initial I-time setting
- <1kg 0.25 – 0.30 sec minimum 0.20 seconds
- 1-2kg 0.30 – 0.40 sec minimum 0.20 seconds
- 2-3kg 0.35 – 0.45 sec minimum 0.25 seconds
- 3-4kg 0.40 – 0.60 sec minimum 0.30 seconds
c. Ideally set using Flow-time graphics
d. This alters I-time and I:E ratio
e. Increase & decrease to reach target settings as appropriate
f. Watch for air trapping at rates >40 in neonates >3kg;
they may need I-time >0.40 to complete inspiration &
prevent air trapping.
g. If neonate using expiratory muscles, try decreasing I-time
slightly (increasing flow).
h. If I-time gets too short, consider switch to PRVC.
9. I-Rise time: a. 10 if < 33 weeks gestational age
b. >5 if >33 weeks gestational age
c. Basically, the smaller the ETT the higher this should be to
create laminar flow and a pseudo sign wave.
d. Increase for bronchospasm (slow rise time, longer e-time)
10. PIP limit: 2 – 3 > PIP (all other alarms as appropriate.)