Respiratory Therapy Cave

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Neonatal and Pediatric Guidelines and Calculators

Determining Neo and Peds ETT, laryngoscope, and Ideal Tidal Volume: Setting up CPAP for a neonate:
Age Weight ETT Laryngo Cm @ Cm @ Min Max 1. 5–6 CWP good place to start
(kg) scope lipline Nasal VT VT 2. 7 – 8 CWP if FiO2 needs
>60%, or signs increased SOB
Premature 0.5 – 1 2.5 Straight 3-6 Neo VT chart 3. If SpO2 > target range, down
Premature 1. – 2 2.5 – 3.0 Straight 7–8 9 Neo VT chart FiO2 by 5–20, then allow 4
Term 3.0 3.0 – 3.5 Straight 9 – 10 Neo VT chart minutes for stabilization
3 months 5.5 3.5 – 4.0 Straight 27.5 38.5 between each change.
6 months 7 3.5 – 4.0 Straight 10 35 49 4. If SpO2 < target range, up
1 years 10 4.0 – 4.5 Straight 11 14 50 70 FiO2 by 5–20, then wait 4 min
2 years 12 4.5 – 5.0 Straight 12 60 84 for stabilizing between changes
3 years 14 5.0 any 13 17 70 98 5. Continue assuring AW patent,
4 years 16 5.5 any 80 102 HR > 100, & infant not apneic.
5 years 18 5.5 Any 15 19 90 116
6–7 20 6.0 Any 100 130 Suspected PPHN:
years 22 110 - Target SpO2 = 96 – 99%
8 – 10 25 6.0 – 6.5 18 125 175 - Do pre and post-ductal SpO2s
years Any - Pre-ductal: SpO2 = right arm
30 150 210 ABG = R. Radial
10 – 12 30 6.5 Any 22 - 24 150 210 - Post-ductal: SpO2 = feet
years 35 175 245 ABG = umb.artery
12 – 14 35 7.0 Any 175 245 - If PO2 difference >15mmHg=
years 40 200 280 R to L shunt of Ductus ateriosis
Suspected cyanotic heart disease:
40 Any 200 280 - Consider 100% O2 challenge
45 Any 225 315 - If no response in pt. with no
1) ETT Size in ID (mm) = 4*(Age/4) 2) Depth oral = Age+13 or 3*ETT size/2 or 6+wt(kg) respiratory distress, transfer pt.
3). Tidal Volumes based on pediatric guidelines of 5-7cc/kg ideal body weight
4) For neonates, the NRP suggested guideline for securing the ETT is weight in kg = 6 (2kg+6 = 9cm at lip)

Normal Pediatric Respiratory Rate and Heart Rate Guidelines for Set-up of ventilator for Pediatrics:
Kg Asleep Awake HR Severe 1. Pt Range: Pediatric (if ideal VT > 40cc<400)
RR RR Distress 2. Mode: PC if < 10kg, otherwise PRVC
0-1 day 30-40 94-145 3. VT: 5-7 cc/kg post-term to 14 YO
1-7 day 30-40 120-160 4. PIP: Not > 30
8-30 day 30-40 115-190 5. PEEP: Start 4 – 5 CWP
Infant to =<4 30-40 40-70 120-130 RR>60 6. FiO2: 5 – 10% above pre-intubation
1 month adjust to maintain desired SpO2.
Infant to =<7 22-30 55-75 130 RR>50 7. Rate: Normal for age
6 month 8. I-time: a. Maintain I:E of 1:2
1 year =<10 16-24 25-42 120 RR>40 9. I-Rise time: As appropriate for patient to
2-3 years 12-14 14-26 20-36 115-125 RR>40 create pseudo sign wave.
4-5 years 16-18 16-20 18-32 100-110 RR>35 10. PIP limit: 2-3 >PIP (other alarms as
6-8 years 20-26 12-16 16-30 90-100 RR>30 appropriate)
10-12 32-42 12-25 75-85
>14years >50 12-18 70-100 Higher PIP & VT may be needed in certain cases. Consult physician if
unable to ventilate at recommended settings. Settings may also be unique
respiratorytherapycave.blogspot.com 09/07/2009 to your particular ventilator, or protocols at your particular hospital.