# Infant Ventilation Rate



## i5adam8 (Oct 3, 2009)

I have been getting some conflicting answers on this and wanted to know if someone could clear it up for me.What is the correct rate for ventilating an infant with a BVM, and after intubated according to the NREMT?


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## dewd09 (Oct 3, 2009)

Forty? 120/3=40

120 Compressions; 3 compressions to 1 vent; 40

Guess it depends on what the protocols say, that you would be using.


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## cm4short (Oct 3, 2009)

To get the correct answer; It would probably be best to consult with a neonatal nurse. Ventilation plays a different role depending upon the age.


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## rescue99 (Oct 3, 2009)

i5adam8 said:


> I have been getting some conflicting answers on this and wanted to know if someone could clear it up for me.What is the correct rate for ventilating an infant with a BVM, and after intubated according to the NREMT?



http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-188


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## Melclin (Oct 3, 2009)

dewd09 said:


> Forty? 120/3=40
> 
> 120 Compressions; 3 compressions to 1 vent; 40
> 
> Guess it depends on what the protocols say, that you would be using.



I remember there being endless confusion in my class when I did this at uni last year. 

Its not 120 compressions. Its a rate of 120 'events' per minute. 

90 compressions, 30 vents @ a rate of 120/min. Or at least that's what we've been told. 

But am I correct in thinking the question is if there's an advanced airway in place and you don't pause compressions for vents how do you re adjust your rates because without the pause the vents go up to forty as dewd mentions?


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## dewd09 (Oct 4, 2009)

If they're intubated, at least in an adult, we bag while they're doing compressions. There's enough time to squeeze. 40 to 60 ventilations on an intubated infant.  Of the half dozen ish infant cardiac arrests, only two were intubated. I didn't bag, I compressed, and just kept going, nobody said anything, so I assume they bagged in between compressions. Only two were successful resuscitation's w/ patent airways; and the rest were "for the family" type deals.


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## cm4short (Oct 5, 2009)

Surfactant is produced till after 34 weeks. This inhibits the premature babies lung wall from sticking to each other. Neonatal techniques to prevent this involve rapid, low volume ventilations.


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## VentMedic (Oct 5, 2009)

Melclin said:


> I remember there being endless confusion in my class when I did this at uni last year.
> 
> Its not 120 compressions. Its a rate of 120 'events' per minute.
> 
> ...


 

Careful with confusing neonatal resuscitation and infant CPR. 

Neonatal is a rate of 120 events per minute and we do pause for breaths with an ETT with neonates.

Infant CPR is different as the AHA has tried to make the numbers consistent.

Summary of all the 2005 changes:

http://www.americanheart.org/downloadable/heart/1132621842912Winter2005.pdf

Neonatal
http://www.aap.org/nrp/apppendix/E/KeyPointsforLessons1Through9.pdf

Of course, other countries may not follow AHA guidelines.


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## Melclin (Oct 5, 2009)

Ahhh of course. My mistake. Isn't my face red.

Cheers Vent.


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## VentMedic (Oct 5, 2009)

cm4short said:


> Surfactant is produced till after 34 weeks. This inhibits the premature babies lung wall from sticking to each other. Neonatal techniques to prevent this involve rapid, low volume ventilations.


 
Surfactant production doesn't stop at 34 weeks.  The Type 2 alveolar cells (pneumocytes) form at about 20 weeks gestation and start producing surfactant between 24 - 28 weeks.  The surfactant decreases surface tension in the alveolus during expiration, allowing the alveolus to remain partly expanded, thereby maintaining a functional residual capacity.  In premature infants, an absence of surfactant results in poor pulmonary compliance, atelectasis, decreased gas exchange, and severe hypoxia and acidosis.  Thus, surfactant is given at birth through an ETT in hopes of preventing Respiratory Distress Syndrome (RDS) and Hyaline Membrane Disease (HMD).  Without the surfactant, whatever ventilator or ventilation strategy used will result in some damage.


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