Formula For Pediatric Ventilation Volume

[AnthonyM83]

A doctor at a pediatric medical center mentioned a formula for bagging pediatrics (or maybe all people). I didn't catch it since there was a lot going on. It was based on weight. Anyone know the standard?

I recently realized how little I know about BVMs and ventilatory volumes or airway in general, as far as numbers (I obviously know the rates...but I had never played with my BVMs and read total volume, stroke volume, percent O2 per flow rate etc that's in the little manuals each bag has).

[spenac]

A doctor at a pediatric medical center mentioned a formula for bagging pediatrics (or maybe all people). I didn't catch it since there was a lot going on. It was based on weight. Anyone know the standard?

I recently realized how little I know about BVMs and ventilatory volumes or airway in general, as far as numbers (I obviously know the rates...but I had never played with my BVMs and read total volume, stroke volume, percent O2 per flow rate etc that's in the little manuals each bag has).

Think we need vent medics help on this one. I have seen some info during school and they will cover in depth someday. Sorry no help but I want more info to. Great question.

[AZCEP]

This really becomes important when you are dealing with ventilators. Kudos for a great question once again Anthony 8)

Typically, volumes are 4-6 mL/kg. When using a BVM the standard from AAP is to ventilate enough to get chest rise then allow for a full exhalation before giving another ventilation.

[letmesleep]

I'm also not as educated on this issue as I would like to be, but I do believe in my recent PALS class the AHA is saying that 8 to 12 is recommended per minute......I do need to double check that, but I'm almost positive thats what they said.

[WelshMedic]

Using a formula is difficult with a BVM. What you need to do is ensure that know the size of BVM you are using and what it's total volume is. I also subscribe to the opinion that ventilating just enough so that the chest wall starts to rise is sufficient. Barotrauma is a very real possiblity in kids.

WM

[VentMedic]

This really becomes important when you are dealing with ventilators. Kudos for a great question once again Anthony 8) .

There are many, many formulas for various methods and protocols for the ventilation of children. If you see an RRT or RN bagging "outside of BLS or standard PALS" guidelines, it may be because they already know something about the type of ventilation the child needs.

Here is an article that is very indepth for different ventilation methods in the pedi population.

http://www.rcjournal.com/contents/04.03/04.03.0442.pdf

Typically, volumes are 4-6 mL/kg. When using a BVM the standard from AAP is to ventilate enough to get chest rise then allow for a full exhalation before giving another ventilation.

Chest rise with adequate time for exhalation is still a good guideline. The 4 - 6 ml/kg is a good average. In the hospital we have formulas for correct ventilator settings from the ABGs along with disease/disorder driven protocols.

Different BVMs have been analyzed in multiple studies and all vary to some degree for delivery which is also operator dependent. Unless you have the capability to monitor each breath for volume, visual assessment of vital signs, color, breath sounds and chest rise will be your best "formula".

ETCO2 monitoring is good to stay consistent. The ETCO2 and the PaCO2 may not match due to some type of disease process or V/Q mismatching.

You may also see a Neo/Pedi team using a BVM to 21% or on O2 but without the reservoir for FiO2 less than 0.40. The possibilities are endless in the world of peds with their many anomalies both repaired and not repaired along with the many causes of RDS.

When you are starting with the unknown, follow your BLS or PALS guidelines and adjust from there according to your visual and physical assessment.