Bump. Does anyone know of a good resource for learning vents? A book or website or something? Also feeds and blood gases. I'm going to the NICU in 3 months and I've never had any ICU experience before.
Not specific to NICU per se, but the LearnICU.org site from the Society of Critical Care Medicine is a great resource and it has a PICU section here:
http://learnicu.org/Fundamentals/RICU/Pages/PICUModules.aspx
Some of the topics have audio, most dont, but it's a good place to start.
Overall, when I talk with medical students about vents, I take a very barebones approach.
First - ignore all the considerations of vent modes as the acronyms mean different things on different vents. But, understand that essentially all modes come down to either pressure control modes and volume control modes, and in their purest forms if you're in one of these modes than you've lost control of the other variable (ie, if you're in a pressure control mode, you can't set a tidal volume, and vice versa). All the fancy modes on a conventional ventilator are just riffs off of PC and VC.
Second - remember that the big reason for using vents (not necessarily in the NICU) is for ventilation - getting rid of CO2. We have a million different ways to improve oxygentaion, but if you can't get rid of CO2 properly, you need a machine to do the work for you.
Third - there are only so many settings you can control on a Vent. The basics are your PEEP (positive end expiratory pressure), PIP (peak inspiratory pressure), the FiO2, the tidal volume and your rate...tinkering with these basic settings will get you pretty far in most cases. The best way to think about these settings are simply, which will affect oxygenation, and which will affect ventilation. That dichotomy will help as you manage patients.
For getting rid of CO2, remember that minute ventilation is rate X tidal volume. If you've got too much CO2, you need alter these items. You're obviously going to be following your blood gases to find out your PaCO2
For oxygenation, obviously FiO2 is your first weapon, but O2 is harmful and toxic in many situations, and so avoiding 100% FiO2 is a wise idea. While you can use PaO2 on your blood gas to help guide your management, there are a limited number of situations where that's what's driving my decision making. Pulse oximetry is incredibly useful for that reason. But if you're maxed out on your FiO2 and the baby is still hanging out in the low 80's (and you know the child doesn't have a heart defect), you have to do something right? That's where PEEP becomes important. Without getting too far into the physiology, just know that increasing your PEEP is critical for "alveolar recruitment", the more alveoli that are open, the more surface area you have for gas exchange. Adjusting your PIP's can help with this (and in pressure control increases your tidal volume) but the overall effect is less because you spend much less time at that PIP.
That's the nitty gritty, and I think it's enough to at least allow you to make some decisions the first day.
