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Section 6 — Respiratory Management Verify against local policy v1.0 · July 2026 Baylor Ed. 33 cross-checked Sept 2026

Chapter 6.7 — Mechanical Ventilation Principles

Lung-protective ventilation: non-invasive first, volume-targeted ventilation, permissive hypercapnia, the DOPE approach to acute deterioration, and extubation readiness — built on West Midlands Neonatal Guidelines 2025–28 and current evidence

Educational guideline — verify locally. Specific ventilator settings, target ranges, and blood-gas thresholds are gestation- and disease-specific and must follow local policy and attending direction. This page summarizes principles, not device-specific prescriptions. Does not replace attending judgment.
BEDSIDE ACTION BOX

1. Overview

Overview

Mechanical ventilation supports gas exchange while the neonatal lung recovers, but the ventilator itself injures the lung (volutrauma, barotrauma, atelectrauma, oxygen toxicity), contributing to bronchopulmonary dysplasia and air leaks. The guiding philosophy is therefore lung protection: avoid intubation where possible (non-invasive support), use volume-targeted ventilation, keep tidal volumes/pressures and oxygen as low as effective, tolerate higher CO₂ (permissive hypercapnia), and extubate as soon as feasible.

Why This Topic Matters

How we ventilate directly shapes outcomes — over-ventilation drives BPD, air leaks, and hypocarbia (linked to brain injury), while under-recruitment worsens oxygenation. Applying lung-protective principles reduces harm.

2. Who This Guideline Applies To

Scope
  • Neonates receiving non-invasive or invasive respiratory support.
  • Teams making decisions about intubation, ventilator settings, and extubation.
  • Cross-references: RDS/surfactant (6.1), BPD (6.2), PPHN (6.3), MAS (6.5), air leaks (6.6), and apnea/caffeine (2.4).

3. Key Definitions

TermDefinition
PEEPPositive end-expiratory pressure — maintains functional residual capacity/oxygenation.
PIPPeak inspiratory pressure.
Tidal volume (VT)Volume delivered per breath (target-controlled in VTV).
VTVVolume-targeted ventilation — targets a set tidal volume, adjusting pressure.
Permissive hypercapniaAccepting higher CO₂ with acceptable pH to limit ventilator injury.
HFOVHigh-frequency oscillatory ventilation — small volumes at high rates.

4. Non-Invasive Support First

Avoid Intubation Where Possible
  • Early CPAP (± non-invasive positive-pressure ventilation) is first-line for many preterm infants and reduces the need for intubation and BPD.
  • Combine with surfactant via less-invasive routes (LISA/InSurE) for RDS where appropriate (see 6.1).
  • Use caffeine to support respiratory drive and successful non-invasive support (see 2.4).

4+. Baylor Ed. 33 Non-Invasive Support: NIPPV, CPAP, High Flow and Weaning

NIPPV
  • Use: as an alternative to CPAP — either as primary support on admission or after extubating a VLBW infant. Evidence: a 2016 meta-analysis found early NIPPV reduced intubation compared with CPAP in preterm RDS; a 2017 Cochrane review found fewer extubation failures up to 7 days (NNT 8); a 2021 meta-analysis found less BPD. Most data come from infants ≤32 weeks, and benefit as "CPAP rescue" is unstudied.
  • Contraindications: an inadequate seal (choanal atresia, severe cleft lip or palate), cardiorespiratory instability, or no way to vent the stomach (e.g., oesophageal atresia without an OG tube). Complications: skin breakdown, abdominal distension, feed intolerance.
  • It raises mean airway pressure but does not substantially support minute ventilation. Check a gas within 60 minutes of starting and at least daily for the first 2–3 days.
Initial NIPPV settings (Baylor Table 16-1)Primary NIPPVAfter extubation
PIP20–222 above the PIP reached on the ventilator
PEEP5–6Same as on the ventilator
Rate2020
Ti0.5 s (longer than on the ventilator, because circuit resistance is higher)0.5 s
FiO₂To the SpO₂ target
Running and weaning NIPPV
  • Always vent the stomach with a working OG/NG tube. Raise PIP by 1–2 to a maximum of 26 (higher worsens gastric insufflation); a rate above 30 may prevent reaching the set PIP. For high FiO₂, raise PEEP by 1 to a maximum of 8.
  • Breaths are unsynchronized, so match the rate to the infant's own as far as possible. Wean once a day — PIP by 2 or rate by 5 — on gases, FiO₂ and apnea frequency. Move to CPAP at PIP 16–18, rate 10–15 and PEEP <7. Use NIPPV as a 7–14 day bridge, not long term.
  • Consider reintubation for moderate to severe work of breathing, PCO₂ rising above 65, more than 3 apnea/bradycardia/desaturation events per hour, or any event needing bag ventilation.
CPAP and high-flow cannula
  • Trial non-invasive support for every infant <32 weeks, or any infant with respiratory distress needing >30% oxygen. Baylor uses bubble CPAP (observational data suggest better gas exchange; low-grade evidence): start at 5–6 cmH₂O, step by 1–2, usually 5–8; above 8 is rarely indicated and can over-distend. Inadequate response: persistent oxygen need above 40% or severe apnea. Pharyngeal function usually improves after 31–32 weeks PMA.
  • Interface: nasal mask is preferred — pooled trials show lower CPAP failure within 72 hours than prongs, with no difference in nasal injury (low-quality evidence). Use prongs only transiently if the mask is not tolerated, and score the skin. A RAM cannula may be used for facial malformations, a head too large for the interface, MRI, or palliative or home transition — add 1–2 to the PEEP for the lower transmitted pressure.
  • Home CPAP has been arranged for a few infants in whom tracheostomy carries more risk than benefit, is refused, or who are going home to hospice. There are no efficacy or safety data; plan it with pulmonology.
  • High-flow nasal cannula: delivered pressure depends on flow and leak — about 0–3 cmH₂O with a 30–50% leak, but potentially high with a tight fit above 1–2 L/min — and cannot be monitored. Flows of 3–8 L/min may wash out nasopharyngeal dead space. Not recommended as primary support in infants <28 weeks or in VLBW infants with respiratory distress. In ELBW infants, CPAP is better after extubation, and a retrospective series linked high flow to more death or BPD. At ≥28 weeks, post-extubation outcomes are similar to CPAP, with less nasal trauma. As primary support, high flow is inferior: in one trial of infants >31 weeks, treatment failure at 72 hours was 20.5% versus 10.2% on CPAP.
Weaning CPAP and cannula (non-BPD infants)
  • Ready to trial off CPAP when all of these apply:
    • PMA ≥32 weeks if born ≤28 weeks, or ≥30 weeks if born >28 weeks, and FiO₂ ≤30% (both strong recommendations, low-certainty evidence).
    • No respiratory distress (RR <60, no significant retractions).
    • No current treatment for PDA or sepsis, no significant apnea or bradycardia, and no major congenital anomaly.
  • From CPAP 5–6 on FiO₂ ≤30%: if needing 21%, go to room air (SpO₂ >90% acceptable); if <25%, go to low-flow cannula (not for relieving distress); if 25 to <30%, go to high flow at 2 L/min with blended oxygen. On high flow, wean every 12–24 h; if FiO₂ ≥30% or distress, increase to a maximum of 4 L/min, then return to CPAP.
  • Target SpO₂ 90–95%; if consistently above 95%, wean oxygen to limit ROP risk. Below 1 L/min, wean by flow or use a blender.
  • Effective FiO₂ on low flow (Walsh tables, reproduced by Baylor as Tables 16-2a/b): a factor from flow and weight is combined with the delivered oxygen concentration. Rule of thumb: when flow in L/min exceeds weight in kg, effective FiO₂ equals the cannula oxygen concentration. Examples in a 1 kg infant on 100% oxygen: 0.125 L/min ≈ 0.30; 0.25 L/min ≈ 0.41.
  • Oxygen reduction test at 35 weeks PMA (NICHD method):
    • Eligible: infants holding SpO₂ 90–95% on FiO₂ ≤25% with no distress, apnea or bradycardia. Not eligible: FiO₂ >25%, any positive pressure or high flow, a rise in baseline oxygen of more than 10% in 24 h, or congenital anomalies.
    • Setup: not fed in the last 30 minutes, supine, on monitoring. Record HR, RR, SpO₂ and events every minute from 15 minutes before, through the test, and for 30 minutes after.
    • Procedure: reduce flow by 0.1 L/min every 5 minutes to 0.1 L/min, then oxygen concentration by 20% every 5 minutes to 21%. Take the cannula out of the nares but leave it taped on.
    • Pass: SpO₂ ≥90% in room air (rapid pass: ≥96% for 15 minutes). Fail — restore baseline oxygen immediately: SpO₂ <90% for 5 consecutive minutes, <80% for 15 seconds, or worsening apnea or bradycardia.

5. Modes & Parameters

What the Settings Do
  • Volume-targeted ventilation (VTV) is preferred over pressure-limited modes — it delivers a consistent tidal volume, reducing volutrauma, pneumothorax, hypocarbia, and death/BPD.
  • Oxygenation is driven mainly by FiO₂ and mean airway pressure/PEEP; recruit atelectatic lung with adequate PEEP.
  • CO₂ clearance (ventilation) is driven by tidal volume × rate (minute ventilation); adjust these to target CO₂.
  • Synchronized modes (e.g., SIMV, assist-control/PSV) improve comfort and gas exchange; set an appropriate inspiratory time.

6. Targets

Gentle, Disease-Specific — Default Targets (Baylor Ed. 33)
  • Oxygen saturation: 90–95% for preterm infants to 36 weeks PMA and for BPD without pulmonary hypertension; 92–95% with BPD-associated PH (Table 16-13, 6.2); pre-ductal 91–95% in PPHN (6.3).
  • CO₂: PCO₂ around 60 mmHg is acceptable with an adequate pH; correct PCO₂ below 35 promptly (cerebral vasoconstriction, over-distension).
  • Tidal volume (volume guarantee): 4–6 mL/kg — 4.5–5.0 below 1000 g, 4.0–4.5 above. Early (evolving) BPD 5–8 mL/kg; established severe BPD may need 10–12 mL/kg (section 8+).
  • PEEP: 4–5 cmH₂O in normal lungs, up to 8 in poorly compliant lungs.
  • Adjust for the disease (e.g., higher pressures may be needed in stiff lungs; watch for air trapping in obstructive disease).

Other sources: the West Midlands guidance this page was first built on leaves exact saturation, CO₂ and tidal-volume targets to local policy; apply one set consistently.

7. Acute Deterioration on the Ventilator — DOPE

D
Displacement
ETT displaced/dislodged (too high, esophageal, extubated) — reassess position; re-intubate if needed.
O
Obstruction
ETT blocked by secretions/kink — suction or replace the tube.
P
Pneumothorax
Transilluminate; decompress a tension pneumothorax immediately (see 6.6).
E
Equipment
Ventilator/circuit/gas failure — disconnect and hand-ventilate; check the equipment.
✓
If in doubt
Disconnect from the ventilator and hand-ventilate with a bag; auscultate; call for help.

8. High-Frequency Ventilation

Rescue & Selected Use
  • HFOV delivers very small tidal volumes at high frequency around a set mean airway pressure — useful for severe respiratory failure, air leaks/PIE, and some PPHN/hypoplasia.
  • Oxygenation is set by mean airway pressure (recruitment); CO₂ by amplitude and frequency.
  • Rescue, not routine primary use: consider when conventional PIP reaches ≥30 or MAP exceeds 12–14 cmH₂O (10 below 1000 g), or at ≥34 weeks with ECMO risk alongside iNO (settings in section 8+).

8+. Baylor Ed. 33 Ventilator Protocols: Tube Position, Volume Guarantee, HFOV and Jet

Confirming and keeping the tube
  • Confirm the tube: the best signs are a rising heart rate and a colorimetric CO₂ detector turning yellow; chest rise and bilateral breath sounds support them. On X-ray the tip should sit above the carina at T3–T4, with the head midline (neither flexed nor extended) and the arms at the sides. Repeat the film after about 500 g of weight gain on the ventilator.
  • Stylets can injure the trachea — keep the tip proximal to the end of the tube. Secure the tube with tape or a securement bar, and check it every shift to prevent unplanned extubation.
  • Laryngeal mask for failed intubation, especially with upper-airway malformations: size 1 below 5 kg, size 1.5 for 5–10 kg. It can obstruct at the tongue base or on a folded-down epiglottis — if so, deflate, remove and replace it. Watch for gastric insufflation with prolonged use.
Conventional ventilation — volume guarantee first
  • Open the lung with PEEP: 4–5 cmH₂O in normal lungs; up to 8 in poorly compliant or atelectatic lungs. Higher levels may be needed for tracheobronchomalacia, which is airway collapse rather than lung collapse. Excess PEEP impairs venous return and lymphatic drainage and can over-distend the lung.
  • Volume-targeted ventilation reduces death or BPD, severe IVH and air leak compared with time-cycled pressure-limited ventilation (Cochrane, 12 trials). Baylor uses pressure-controlled assist-control with volume guarantee as the primary mode below 32 weeks PCA.
  • Starting settings:
    • Target Vt 4–6 mL/kg — 4.5–5.0 below 1000 g, 4.0–4.5 above 1000 g — adjusted in 0.5 mL/kg steps.
    • Pmax 25–28 at first, then 3–5 above the working PIP. Manual breaths are delivered at Pmax and are not volume-controlled, so keep lowering Pmax as compliance improves.
    • PEEP 5 or more; low-Vt alarm at 90% of target; trigger at maximum sensitivity.
    • Ti 0.3 s (slope 0.08 s; below 0.25 s, reduce slope to 0.02–0.04).
    • Backup rate 30; circuit flow 6–8 L/min.
  • Low-Vt alarm causes: Pmax too low, large tube leak or malposition, forced exhalation, abdominal splinting, worsening lung mechanics, or Ti too short. Volume guarantee works with leaks up to about 45–50%; beyond that, reposition the infant or tube, or occasionally re-intubate with a larger tube. Too long a Ti shows on the graphics as a pressure plateau after flow has stopped.
  • Weaning: PIP falls automatically as compliance improves. In assist-control the infant sets the rate, so wean FiO₂ and target Vt. Do not go below 4 mL/kg — at that point the infant is effectively on tube CPAP, so extubate.
  • SIMV starting settings: rate 20–40, PIP 20–25 (or enough for 4–6 mL/kg without volume guarantee), PEEP 5, Ti 0.3–0.4 s. Pressure support needs 10–15 cmH₂O above PEEP to overcome small tubes and circuits. Adding it to SIMV steadied SpO₂ and reduced ventilation at day 28, but did not change total ventilation days or oxygen at 36 weeks.
  • Gas targets: PCO₂ around 60 is acceptable; correct PCO₂ below 35 promptly (cerebral vasoconstriction, over-distension — especially just after surfactant). Consider rescue HFOV if PIP reaches ≥30, MAP exceeds 12–14 (10 below 1000 g), or severe hypercapnia persists.
Ready for extubation (Baylor Table 16-5)AC + VGSIMV + VGSIMV pressure controlAC pressure control
Vt or PIP4–5 mL/kg (PIP <25)4–5 mL/kg (PIP <25)PIP 20PIP 20
MAP8–10
PEEP5–6
RateBreathing above backup rate of 3020–2520–25Breathing above backup rate of 30
FiO₂≤30%
When BPD is established: change the strategy (Table 16-6)
  • Early lung (prevention): the lung is relatively uniform with short time constants. Use Vt 5–8 mL/kg, short Ti, enough PEEP to recruit without over-distension, the lowest FiO₂ that holds SpO₂ at 90–95%, and permissive hypercapnia.
  • Ventilator-dependent ELBW infants need a rising Vt with age as dead space grows — on average 6 mL/kg (5–8) beyond 3 weeks.
  • Severe or "classic" BPD: uneven airway resistance, gas trapping and heterogeneous aeration. Use larger Vt 10–12 mL/kg, longer Ti ≥0.6 s, slower rates of 10–20 to allow emptying, and moderately high PEEP to splint collapsing airways; SIMV plus pressure support plus PEEP on a demand-flow ventilator often suits (weak recommendation, low-quality evidence). Rates above 20–30 cause gas trapping. Pressure control may distribute gas better than volume targeting with severe uneven obstruction. Over-distension can increase agitation and paradoxically worsen ventilation.
  • Weaning chronic ventilation: make small changes, allowing several days between each, because deterioration can take days to show. Once FiO₂ is ≤50%, test with a small cut in rate or PIP (Vt), or lengthen the time on pressure support alone. Watch SpO₂ closely to protect against pulmonary hypertension and cor pulmonale (see 6.2). The role of CPAP or high flow after extubation in BPD is poorly studied.
High-frequency oscillation
  • Elective HFOV for RDS has shown no consistent long-term benefit over rescue use, and more air leak. Risks are tracheal injury, hyperinflation and air leak; over-distension may impair venous return and raise IVH risk.
  • Indications:
    • Infants ≥34 weeks at risk of needing ECMO (PPHN, sepsis, pneumonia, RDS, meconium aspiration, CDH, hypoplasia) — HFOV plus iNO reduced ECMO more than either alone, and iNO can be given through the oscillator.
    • Severe acute lung disease with conventional PIP ≥30 or MAP >12–14 cmH₂O (>10 below 1000 g) (weak recommendation).
    • Severe air leak with persistent hypoxaemia.
  • Oxygenation = mean airway pressure. Start 1–2 cmH₂O above the conventional MAP in VLBW infants, 2–3 above in term infants, and increase until oxygenation is adequate (trial averages 11–19). Wean FiO₂ first; once FiO₂ is below 60–70%, wean Paw by 1–2.
  • Ventilation = amplitude (ΔP). The tube absorbs most of it — about 80% through a 3.5 mm tube and 90% through a 2.5 mm tube — so use the largest, shortest, straightest tube. If PCO₂ stays high at maximum ΔP, lower the frequency to reduce tube attenuation.
  • Non-uniform disease (meconium aspiration, pneumothorax, PIE): wean Paw and ΔP, and accept higher PCO₂, lower PaO₂ and FiO₂ above 0.7, because gas trapping is the danger.
  • Chest films: within 1–4 h, every 12 h for the first day, then daily. Aim for diaphragms at T8.5–T9 — not in CDH or pulmonary hypoplasia. Suction only as needed; reposition the infant and head every 3–4 h.
  • Warning signs: unexplained bradycardia can mean compliance has improved suddenly, so wean pressures. A sudden PCO₂ rise with falling PO₂ suggests airway obstruction or tube malposition.
  • Back to conventional ventilation once any air leak has resolved, Paw is 10–12, ΔP is below 30, and gases are stable.
High-frequency jet — starting settings (Baylor Table 16-8)SettingComment
Jet rate360–420Usually start at 420; change in steps of 60
Jet Ti0.02 sDo not change
Jet PIP20–25Usually 1–2 below the conventional PIP
Conventional rate0–5Avoid sigh breaths if possible
PEEP5–12Set from the MAP the conventional ventilator was giving
Sigh breath Ti / PIP0.4–0.6 s; 50% of jet PIP or 5–8 above PEEPSigh breaths can cause lung injury and shear
Running the jet
  • Use: after failed conventional ventilation, high conventional support, or failed HFOV — particularly for air leak (PIE, pneumothorax, blebs) and non-uniform disease (meconium aspiration, CDH). The jet runs in tandem with a conventional ventilator, which supplies PEEP and optional sigh breaths. Exhalation is passive, with an I:E ratio of 1:4 to 1:12 (oscillator 1:2). Check a gas within 30 minutes and a chest film within 1 hour.
  • Jet ΔP (PIP − PEEP) sets PCO₂; conventional PEEP sets MAP and oxygenation. Avoid sigh breaths except briefly to recruit collapsed lung.
  • Weaning oxygenation: wean FiO₂ alone until ≤0.50 (unless over-inflated). Then lower PEEP and jet PIP together by 1 every 4–8 h, lowering any sigh PIP by the same amount. Once FiO₂ is ≤0.30–0.35, lower them by 1–2 every 2–4 h to avoid over-inflation.
  • Weaning ventilation: reduce jet PIP by 1–2 whenever PCO₂ falls below target, down to PIP <20 with ΔP <10. If PCO₂ is still below 35 at minimal ΔP (about 3) and the infant is not ready to extubate, drop the rate to 300, then 240.
  • Trial extubation (Table 16-10): PIP <20, PEEP <7–8, ΔP <10, FiO₂ ≤0.35.
  • Troubleshooting:
    • Atelectasis — raise PEEP, with cautious temporary sigh breaths.
    • Hypotension — lower PEEP and PIP, or the rate (not below 240), to reduce MAP and trapping.
    • Over-inflation — first stop sigh breaths, then lower PEEP, PIP or rate.
    • Servo pressure rises with improving compliance or a circuit leak, and falls with worsening compliance, tube obstruction, secretions, tension pneumothorax or right main-bronchus intubation.
    • Less chest wiggle — suction and check tube position; more wiggle — check a gas and wean.
Jet adjustments (Table 16-9)Oxygenation poorOxygenation adequateOxygenation too good
CO₂ too lowRaise PEEP, keep PIP (MAP up, ΔP down)Lower PIP (ΔP down); raise PEEP if needed to hold MAPLower PIP until CO₂ acceptable; if over-inflated, lower PIP and PEEP equally
CO₂ rightRaise PIP and PEEP equally (MAP up, ΔP same)No changeLower PIP and PEEP equally (MAP down, ΔP same)
CO₂ too highRaise PIP (ΔP and MAP up); then PIP and PEEP equally if still hypoxaemicRaise PIP (ΔP up)Lower PEEP (ΔP up, avoids over-inflation)
Useful equations (Baylor Table 16-4)Formula
Mean airway pressureMAP = PEEP + (PIP − PEEP) × [Ti / (Ti + Te)]
Oxygenation indexOI = MAP × FiO₂ × 100 / PaO₂
Alveolar gas equationPAO₂ = FiO₂ × 713 − PaCO₂ / 0.8; A–a gradient = PAO₂ − PaO₂
Oxygen contentCaO₂ = (1.39 × SaO₂ × Hb) + (0.003 × PaO₂)
Acute respiratory acidosisΔpH = ΔPCO₂ × 0.008
ComplianceC = ΔV / ΔP; laminar-flow resistance R = 8 × length × viscosity / (π × radius⁴)

9. Extubation Readiness

Extubate as Soon as Feasible
  • Assess readiness daily: low ventilator settings, adequate respiratory drive (on caffeine), acceptable gases, and clinical stability.
  • Extubate to non-invasive support (CPAP/NIPPV) to reduce reintubation and BPD.
  • Optimize before extubation (caffeine, minimal sedation); monitor closely afterward for apnea/atelectasis.

10. Monitoring

ParameterWhenAction
SpO₂ / FiO₂ContinuousTitrate to target; avoid hyperoxia/hypoxia.
Tidal volume / pressuresContinuousKeep lung-protective; investigate changes.
Blood gases (CO₂/pH)SerialPermissive hypercapnia; avoid hypocarbia.
ETT position/patencyOngoing + after movesDOPE for deterioration.
Chest X-rayAs indicatedETT position, lung inflation, air leak.

11. Precautions

Safety Cautions
  • Avoid over-ventilation (volutrauma/barotrauma, air leaks) and hypocarbia (brain injury/PVL).
  • Avoid hyperoxia (ROP/oxidative injury) and hypoxia — titrate to target.
  • For sudden deterioration, run DOPE and hand-ventilate if in doubt.
  • Confirm and secure ETT position; re-check after any move.
  • Prefer non-invasive support and volume-targeted ventilation; extubate promptly.

12. Escalation & Family Support

Family-Centered Communication
  • "The breathing machine supports your baby's lungs while they heal. We use the gentlest settings possible to protect the lungs and aim to move to softer support as soon as we can."
  • "If your baby suddenly worsens, we quickly check the tube, the lungs, and the equipment to find and fix the cause."

13. Key Pearls

High-Value Clinical Pearls
  • Non-invasive support first; volume-targeted ventilation reduces death/BPD, air leaks, and hypocarbia.
  • Oxygenation ≈ FiO₂ + mean airway pressure/PEEP; ventilation (CO₂) ≈ tidal volume × rate.
  • Permissive hypercapnia with acceptable pH; avoid hypocarbia and hyperoxia.
  • Sudden deterioration → DOPE (Displacement, Obstruction, Pneumothorax, Equipment); hand-ventilate if in doubt.
  • HFOV for severe failure/air leaks/selected cases.
  • Assess extubation readiness daily; extubate to non-invasive support with caffeine.

14. Common Mistakes to Avoid

MistakeWhy it harmsBetter practice
Pressure-limited by default.Volutrauma, hypocarbia.Use volume-targeted ventilation.
Over-ventilating to normal CO₂.Lung/brain injury.Permissive hypercapnia (acceptable pH).
Liberal oxygen.ROP/oxidative injury.Titrate FiO₂ to target.
Slow response to deterioration.Arrest.DOPE; hand-ventilate if unsure.
Prolonged intubation.BPD.Non-invasive first; extubate promptly.

15. Board-Style High-Yield Summary

Key Takeaways
  • Ventilator injury (volutrauma/barotrauma/atelectrauma/oxygen toxicity) drives BPD/air leaks — ventilate to protect the lung.
  • Non-invasive support first; volume-targeted ventilation preferred (less death/BPD, pneumothorax, hypocarbia).
  • Oxygenation ≈ FiO₂ + MAP/PEEP; CO₂ clearance ≈ tidal volume × rate.
  • Permissive hypercapnia with acceptable pH; avoid hypocarbia and hyperoxia.
  • Sudden deterioration → DOPE; hand-ventilate if in doubt; HFOV for severe failure/air leaks.
  • Assess extubation readiness daily; extubate to non-invasive support with caffeine.

16. References

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