Forum Deputy Chief
if all we have is an LTV1200 and adult vent circuit, what can we do here to successfully get this patient on the machine? Settings/tips & tricks?
I missed in the original post about the adult circuit.
The main problem with the larger circuit is that with their increased volume, they are effectively much more compliant than the pedi ones. This means that both the "space" and the "stretch" of the tubing can effectively "absorb" pressure and volume differently from breath to breath, and confuse the ventilator's flow sensor and manometer into thinking it is delivering more or less volume than it actually is. In adults it isn't an issue because the compliance changes amount to a very small fraction of what is being being delivered. In a small ped though, it is a much larger part of the desired tidal volume and can potentially cause significant over- or under-ventilation. Even with ped tubing, this kid is right at the lower limit of what the LTV1200 is supposed to be used for (IIRC, 10kg is the smallest?)?
As far as tricks, I don't know if increasing the bias flow (can you even do that on the LTV?) would help, or would that make the vent even more sensitive to the circuit? I imagine adding more PEEP than you otherwise might, and keeping them relaxed and using VCV would probably minimize breath-to-breath changes and the influence that the additional circuit volume and compliance has on what the vent senses. This might work OK on a healthy kid who is ventilating easily, but a kid like the one described here just needs to be carefully hand ventilated if you don't have the proper equipment.