MECHANICAL VENTILATION

Practice Guidelines

These guidelines aim to provide the registered nurse with the guiding principles to effectively
and safely manage a newborn on mechanical ventilation. There must be at least one spare
ventilator set up and ready for use at all times.

1. The circuit and settings must be checked by two RNs.

2. Initial settings - Mode: SIPPV / VG; Sensitivity: 1; Pressure: 25/5; TI 0.3secs; Rate:
40/min; FiO2: 0.21; I:E ratio 1:2.

Reasons for mechanical ventilation in the newborn include

1. Respiratory distress where the infant requires FiO 2 > 0.35 in the first 24 hours, or FiO 2
>0.4 to 0.6 after first 24 hours 1
2. To deliver surfactant
3. Low PaO 2 (hypoxia) and/or high PaCO 2 (hypercarbia) 2
4. In infants less than 30 weeks gestation with an x-ray consistent with RDS and
increasing oxygen requirements there will be a lower threshold for intubation and
mechanical ventilation
5. Infants who do not breathe eg severe neurological insult
6. Stabilisation of the sick unstable infant eg necrotising enterocolitis
7. Prolonged and frequent apnoea not resolved with nCPAP 3
8. Functional or anatomic airway obstruction 4
9. For laser surgery

Overriding principles 2, 5
Achieve sufficient pulmonary gas exchange
Minimise work of breathing
Minimise risk of lung injury and other complications related to mechanical ventilation

To be used in combination with the – intubation, extubation, CPAP, surfactant administration,

conventional & HFO ventilation, nitric oxide, airway suction, developmental positioning and
sedation protocols

Ventilators used in RPA newborn Care

1. Dräger 8000 – This ventilator is routinely used to provide conventional ventilation in

the term and preterm infant. Although not a true oscillator the ventilator can be used to
deliver high frequency oscillation (flow interrupted - passive expiration) in the very
preterm infant less than 1200grammes. The Dräger 8000 can deliver CPAP, IPPV,
SIPPV, SIMV, PSV, VG, PSV & VG, and HFO (flow interrupted). Nitric oxide can be
delivered using the Dräger 8000.

2. Stephanie CE0482 – This ventilator is the preferred ventilator for use in the near term
and term infant. The Stephanie CE0482 can be used to deliver nCPAP, IPPV, SIPPV
(assist control), SIMV (S-IMV), volume targeted ventilation and HFO. It is a powerful
oscillator and is used to deliver HFO in all infants greater than 1200 grammes. Nitric
oxide can be delivered using the Stephanie CE0482.

Modes of ventilation used in RPA Newborn Care

1. nCPAP (Continuous positive airway pressure) maintains an elevated end expiratory
lung volume in spontaneously breathing infants by providing a continuous flow of
heated humidified gas at a set pressure (5-10cmH 2 O) 1. nCPAP in RPA Newborn Care
can be delivered using the Dräger 8000 and rarely the Stephanie CE0482 in infants at
or near term.

RPA Newborn Care Clinical Practice Guidelines

Main author: Ms Maria Daco CNS July 2009, revised December 2010, revised July 2011
Review July 2012
 The Infant Flow Driver (EME, UK) is used for infants < 1200g and / or less than 1200g,
while the Bubbly® CPAP circuit (Fisher & Paykel) can be used for all infants and is
currently the preferred method – see nCPAP protocol.

2. VG (Volume guarantee) this mode of ventilation targets tidal volume – not pressure and
is only available on the Dräger 8000. VG is used in combination with either SIPPV or
SIMV. The aim of VG is to provide a preset tidal volume by automatically adjusting the
PIP (peak inspiratory pressure) to achieve the target tidal volume. SIPPV / VG is now
the routine mode of ventilation in this nursery. Leaks > 40% are not well tolerated in
this method of ventilation – see VG Guidelines http://www.cs.nsw.gov.au/rpa/neonatal/

The Stephanie CE0482 uses volume targeted ventilation and does not automatically
decrease PIP as lung compliance improves. PIP must be reduced by the operator.
Volume targeted ventilation is used to minimise lung over-distention and therefore
minimise lung injury as it compensates for changes in lung compliance, resistance and
spontaneous respiratory effort. 8

3. IPPV (Intermittent Positive Pressure ventilation) – is no longer used in RPA Newborn

Care as it is non synchronous and current evidence suggests synchronised ventilation
results in shorter days of ventilation 6,7.

4. SIPPV (Synchronised intermittent positive pressure ventilation) provides supported (set

PIP and PEEP) ventilator breaths synchronised with the onset of each spontaneous
breath if it occurs within a ‘trigger window’. Therefore, every breath the infant takes is
supported. If the infant does not make spontaneous breaths, the ventilator delivers
mechanical breaths at the back-up rate set by the operator. The infant therefore
“controls” rate of breathing. This mode is used for most infants during the acute period
of ventilation and when muscle relaxed.

5. SIMV (Synchronised intermittent mandatory ventilation): provides supported (set PIP

and PEEP) mandatory ventilator breaths as determined by the back-up rate. The onset of
inspiration of a mechanical breath is synchronised with the onset of the infant’s
spontaneous breath if it occurs within a ‘trigger window’. All other spontaneous infant
breaths above the set rate are only supported by PEEP. If the infant does not make
spontaneous breaths, the ventilator delivers mechanical breaths at the back-up rate set
by the operator. This mode of ventilation is used usually used for weaning.

6. HFOV (High frequency oscillatory ventilation) provides small tidal volumes at a very
fast rate. This results in significantly lower alveolar pressure which reduces the risk of
lung injury caused by excessive pressure and volume5. The Dräger 8000 (flow
interrupted) can deliver up to 1200 cycles /minute (1Hz = 60 cycles per minute) when
in high frequency mode. The Stephanie CE0482 can deliver 300-900 cycles /minute 9
and is the preferred oscillator.

Ventilation parameters
The following ventilator settings are individualised according to the needs of each infant and
the mode of ventilation in use. The registered nurse is responsible for ensuring the ventilator
delivers the correct settings ordered by the medical team / transitional nurse practitioner. The
registered nurse will check the ventilation parameters continuously and document any changes
made. The registered nurse should query any changes / settings that are not understood.

RPA Newborn Care Clinical Practice Guidelines

Main author: Ms Maria Daco CNS July 2009, revised December 2010, revised July 2011
Review July 2012
The registered nurse may change ventilator settings if the infant’s condition
deteriorates immediately after changes to ventilation orders are made. The registered nurse
must notify the medical team / transitional nurse practitioner immediately.

1. Inspiratory time (TI): set time designated for inspiration during a breath (usually set
at 0.3sec).
2. Expiratory time (TE): set interval of time designated for expiration during a breath
(change in rate will automatically change this value). Not routinely documented.
3. Inspiratory : Expiratory (I:E) ratio: the ratio of inspiratory time compared to
expiratory time (usually set at 1:2). The lower the rate set on the ventilator the higher
this ratio will be – the measurement does not quantify spontaneous breaths. Inverse I:
E ratios no longer used.
4. Rate (fset): the set number of supported mechanical breaths delivered over one
minute.
5. Tidal volume: when on VG the standard volume will be initially set at 4mls/kg
6. Hz: The cycles per minute delivered during high frequency oscillation. (1Hz = 60
cycles per minute). Usually start at 10Hz.
7. Oxygen concentration (FiO 2 ): the fraction of inspired oxygen and is set between
0.21-1.00. The registered nurse titrates FiO2 using arterial blood gases, SpO 2 and / or
TCM PaO 2 values.
8. Flow rate (V’insp) & (V’exp): the speed in which the tidal volume is delivered. This
is usually set at 10L/min when using the Dräger 8000. While in conventional modes
the Stephanie CE0482 has a flow rate of 5L/min and this cannot be adjusted by the
operator. Both ventilators automatically adjust flow rates when switched to HFO and
will deliver flow rates up to 30L/min.
9. Peak inspiratory pressure (Pinsp or PIP): the maximum pressure used to inflate the
infants lungs during inspiration on a mechanical ventilator.
10. Positive end expiratory pressure (PEEP): the pressure the ventilator maintains at the
end of expiration to provide continuous distending pressure to the infant’s lungs.
11. MAP (mean airway pressure): average pressure generated by the ventilator over each
inspiratory / expiratory cycle (value will depend on rate / pressures and tidal volumes).
12. Trigger sensitivity (Trig): the volume of gas the infant needs to move to trigger a
mechanical breath when the ventilator is on a synchronous mode. The Dräger 8000
has a range of 1(0.02mls) to 10 (3mls). The trigger is normally set on 1 for preterm
infants. The sensitivity may need to be reduced for term infants. The registered nurse
should discuss with medical team / transitional nurse practitioner (usually set at ≈ 1.6
for term infants). The Stephanie CE0482 has a range of 100 to 290mls. This should be
set at 0.5 or above artefact – observe screen and infant to determine sensitivity8
13. Tidal volume (VT): the volume of gas inspired or expired during a breath. The
desired tidal volume for neonates is 3-4mls/kg1 The Dräger 8000 measures expiratory
TV.
14. Minute volume (MV): the amount of gas that passes in or out of the infant’s lungs
during one minute. (Minute volume = tidal volume x rate). The desired minute volume
neonates is 200-400mls/kg.1

Factors that may increase tidal / minute volume include

increase in PIP
decrease in PEEP
muscle relaxation / sedation
decrease in pulmonary resistance
increase in lung compliance
hyperventilation - increase in spontaneous breathing such as in crying or alert states

RPA Newborn Care Clinical Practice Guidelines

Main author: Ms Maria Daco CNS July 2009, revised December 2010, revised July 2011
Review July 2012
 Factors that decrease tidal / minute volume include
decrease in PIP
increase in PEEP
increase in pulmonary resistance
decrease in lung compliance - pneumothorax
hypoventilation – decrease in spontaneous breathing
restlessness – crying / ineffective muscle relaxation

Nursing Management
Initial assessment of the infant
After intubation of the infant, at admission (birth or NETS) and at handover, thoroughly assess
the infant’s condition. This gives a reference point if the infant’s condition changes.

General assessment: Assess the infant’s colour, perfusion, tone, activity, pain/comfort and
general appearance.

Respiratory assessment: Observe synchrony, adequacy and symmetry of chest expansion,

auscultate quality of breath sounds and note respiratory rate / effort. Note and document if
there is a significant leak around the endotracheal tube. Any leak may be significant if
ventilation cannot be optimised. Note time surfactant was administered.

Measurement of endotracheal tube (ETT): Measure the ETT from the lips or nares to end of
the suction port. This length should be kept at a minimum to prevent mechanical dead space in
the ETT, but should be long enough to allow the ventilator tubing to be positioned midline
without applying pressure on the lips or nares of the infant.

Documentation of ventilator parameters and settings

• At the commencement of each shift, on admission and / or after intubation the
registered nurse will document the size / position of the endotracheal tube, the % leak;
the mode of ventilation and sensitivity used. The position of the ETT on the latest x-
ray.

• Conventional ventilation - document PIP, PEEP, flow, fset, FiO 2 , MAP, MV and VT
every hour. Monitor and document % leak (leak greater than 40% is significant as it
affects the accuracy of the tidal volume delivered). Discuss with medical team.

• Volume targeted ventilation / VG – document mode, sensitivity, target TV and

pressure limit. In addition to documentation for conventional ventilation note range of
pressures delivered and range of volumes delivered. If infant is constantly reaching set
pressure (alarm) in order to deliver the target TV adequate the pressure limit may be
inadequate. Alternatively if infant is improving you may note a fall in the PIP pressure
needed to deliver the target TV and the infant may be self weaning

Humidification Note adequacy of humidification – there should be some misting in the

endotracheal tube and minimal rainout. Ensure sterile water level in the humidifier is
sufficient to facilitate adequate humidification and avoid trauma to the airway.
Remove excess water from circuit. If rainout is excessive consider adjusting humidity
levels and / or insulate the inspiratory limb of the circuit.

Dräger 8000 - The Fisher & Paykel 850 series is used for most modes of ventilation
and is automatically set to deliver 370Cat the patient wye. Record the temperature &
level of water every hour.
Stephanie CE0482 - Ensure that the humidifier chamber is filled with sterile water to
black line. For conventional modes the temperature offset can be set to -2.0 (39.0OC) 27.
Temperature and level of water should be recorded every hour.

RPA Newborn Care Clinical Practice Guidelines

Main author: Ms Maria Daco CNS July 2009, revised December 2010, revised July 2011
Review July 2012
• High Frequency Oscillation- document mode and I:E ratio - Stephanie CE0482 only.
In addition to documentation for conventional ventilation note Hz, amplitude or dP,
target TV will be ≈ 2mls / kg and note rib expansion (8th – 9th rib) on most recent chest
x-ray – see high frequency ventilation protocol.

Humidification Note adequacy of humidification – there should be some misting in the

endotracheal tube and minimal rainout. Ensure sterile water level in the humidifier is
sufficient to facilitate adequate humidification and avoid trauma to the airway.
Remove excess water from circuit. If rainout is excessive consider adjusting humidity
levels and / or insulate the inspiratory limb of the circuit.

Dräger 8000 - The Fisher & Paykel 850 series may be used but more commonly the
circuit is changed to a low compliance or reusable circuit and the Fisher & Paykel 700
series is used with a low volume humidification cassette (MR225 & water feed set
MR190). The temperature is normally set at 390C +2 . This will deliver gas at the patient
wye at 370C. Record the temperature displayed on the humidifier (390C +2 ) and level of
water every hour. Adjustments to the humidity are not uncommon during HFO.

Stephanie CE0482 - In HFO, the temperature offset can be adjusted to -2.0 (39.0OC) 27.
If rainout occurs, the temperature offset can be adjusted in -0.5 steps, and observed for
30 minutes for any improvement. Do not adjust the temperature offset to less than 0.0
from the recommended settings as this will cause low humidity in the inspired gas.
The patient circuit tube warmers should be used to reduce rainout before humidity is
reduced. 8

• Documentation of ventilator changes

Changes of ventilator settings are ordered by staff specialists, fellows, registrars or
transitional nurse practitioners. These changes need to be documented in the progress
notes (near the arterial blood gas results), the intensive care chart and signed by the
doctor/ transitional nurse practitioner and RN. The FiO 2 can be adjusted as necessary
by the RN.

Ventilator alarms
It is important to set the ventilator alarms correctly and note the occurrence of alarms
as it may indicate changes in the infant’s condition.

Dräger 8000
1. Alarm Delay should be set at 20 seconds. In an unstable sick infant and / or an
infant who is muscle relaxed, the alarm delay should be short in order to
immediately alert the registered nurse if there is a change in the infant’s condition.

2. MV alarms: MV should be set according to the infant’s clinical condition. In a sick

infant, the MV should be set at +/-10% of the acceptable range. As the infant’s
condition improves, or during weaning the MV can be set at up to +/-30% of the
acceptable range.
Target TV is 4-7mls/kg 1.
Target MV is 200-400mls/kg1.

3. High frequency alarm: The Panting alarm can be set at 20-200 but defaults to 100
when ventilator is switched off. The high frequency alarm will be activated when
the rate of the ventilator is higher than the level set by the operator. This may
occur if the infant is active and triggering excessive breaths (check sensitivity).
Confirm alarm with infant’s respiratory as mucous / water in the circuit will
trigger auto breaths and inadvertent hyperventilation.

RPA Newborn Care Clinical Practice Guidelines

Main author: Ms Maria Daco CNS July 2009, revised December 2010, revised July 2011
Review July 2012
 4. Apnoea alarm: The apnoea alarm defaults to 20 seconds. It should be set at lower
limits if the infant is ventilator dependent.

5. Tube obstruction: This alarm will be triggered if the ETT / circuit is blocked with
secretions of if it is kinked.

6. Circuit leak: This alarm will alert the registered nurse to a dislodged tube or leak
in the circuit.

7. Humidification (Fisher & Paykel 850 / 750 series) will alarm if the temperature is not
reaching target leves – see humidification for convention and high frequency
oscillation

The Stephanie CE0482

The alarm limits can be set automatically in limits above and below the current
ventilator setting values. This is done by selecting Alarm limits with the rotary dial and
selecting Automatic. Alarms may also be set manually.

Confirm that the ventilator and the humidifier base are connected to the blue back-up
power points. Ventilator tubing is changed every 7 days to reduce the risk of colonisation and
ventilator acquired pneumonia (VAP). Ventilator tubing changes are only performed if the
infant is clinically stable (not HFO or nitric oxide). Ventilator changes are performed by 2
RNs. Ensure the registrar / fellow is in the unit.

Nursing management and additional observations

Monitors: Ensure monitor alarms are checked at the beginning of each shift and / or prn and
are set according to relevant protocols and / or condition of infant. Document same on the
intensive care flow chart. Ensure alarms are active before the infant is left unattended eg when
called to answer telephone enquiries etc.

Infants greater than / equal to 28 weeks may have both pulse oximetry and transcutaneous
oxygen / CO 2 monitoring used 10. Pulse oximetry is used for all infants less than / equal 27
weeks gestation. As skin matures usually more than two weeks postnatal age) and there is a
need to monitor CO 2, application of transcutaneous oxygen / CO 2 monitors is appropriate11.

Manual ventilation: An anaesthetic bag with manometer or Neopuff® with appropriate size
mask must be available for each infant on assisted ventilation or when oxygen requirements
are greater than 50%. These devices must be connected to blended gas and control set at
infant’s target oxygen concentration. Document same on the intensive care flow / oxygen
chart. Ensure gas flow is turned off after checking system and when not in use. This will avoid
accidental hyper oxygenation.

Suction: Ensure that the suction tubing connections are correct at the beginning of each shift.
Document same on intensive care flow / oxygen chart. Suction pressure is set at minus
100mmHg. Ensure suction is off when not in use – negative pressure causes excess noise and
possible trauma if in contact with the infant’s skin. Suction tubing is changed daily and the
circuit is routinely changed Tuesdays, Fridays and Sundays. Suction is generally not
performed within 6 hours of surfactant administration – see suction protocol.

Central venous and arterial line placement: Verify placement of venous and arterial central
lines. If the infant has central and/or arterial lines, proper placement should be confirmed by
inspection of x-rays. Monitor central line and arterial line insertion site and document
pressures hourly – see umbilical / PICC and arterial line
protocols http://www.cs.nsw.gov.au/rpa/neonatal/

RPA Newborn Care Clinical Practice Guidelines

Main author: Ms Maria Daco CNS July 2009, revised December 2010, revised July 2011
Review July 2012
Arterial blood gases - For frequency, method of collection and interpretation – see Arterial
blood gas, arterial line & i-Stat protocols.

Administration of surfactant - for dose, method of administration & observations - see

Surfactant protocols http://www.cs.nsw.gov.au/rpa/neonatal/

Sedation: A morphine infusion is usually prescribed for infants who are intubated and
ventilated in order to provide sedation and comfort – see intubation / sedation protocol Change
the infant’s position with nursing care. Continuously assess the infant’s level of comfort and
alert the fellow/registrar if additional sedation is required. Where extubation is considered
likely within the next 6 – 12 hours infants may not be sedated.

Positioning and pressure care: Minimal handling is used for most infants needing mechanical
ventilation. Position the infant to promote flexion and support the ETT in correct alignment to
avoid pressure on the nares or lips. The infant can be positioned supine, left lateral, right lateral
and prone. Change position before suction and / or with nursing care as appropriate. The prone
position can be used to promote oxygenation12 after umbilical lines have been removed.

Infants who are muscle relaxed, those with oedema and / or shock are at increased risk for
pressure areas – observe and document condition of skin especially the around the ears, sacrum
and heels. Avoid pressure from electrodes, temperature probes and tight tapes etc. Observe for
areas of erythema from use of transcutaneous probes and re consider application. Frequently
check creases in the neck, axilla and groin regions where accumulation of moisture may
facilitate development of excoriation and thrush. Consider use of a soft developmental care
mattress.

Chest physiotherapy
RNs should have a good knowledge of each body position and its use to promote oxygenation
and drainage of secretions. Chest physiotherapy is not routine and the potential advantages for
an individual must be discussed with the duty neonatologist prior to its use – see protocol
Chest Physiotherapy http://www.cs.nsw.gov.au/rpa/neonatal/. RNs must be skilled at
providing chest physiotherapy and the physiotherapist should be consulted to provide
additional support and guidance. The RN should stay and assess the infant’s condition during
chest physiotherapy to administer additional oxygen and support as required 13.

Supporting parents
Admission to the NICU and the need for mechanical ventilation can be stressful for the
parents14. Neonatal nurses are in a unique position to promote attachment and relieve parental
stress14. Informing parents about their infant’s condition, the need for mechanical ventilation
and frequently updating them about their infant’s progress are essential to good nursing care.

Minimising risk and possible complications associated with ventilation

The registered nurse should have a comprehensive knowledge about the possible
complications of mechanical ventilation in order to minimise risk, prevent problems and
provide immediate intervention when necessary.

RPA Newborn Care Clinical Practice Guidelines

Main author: Ms Maria Daco CNS July 2009, revised December 2010, revised July 2011
Review July 2012
Prevention of Endotracheal and Ventilator Complications

Potential Problem Nursing Management – strategies to prevent complications

Confirm placement of ETT with CO 2 detector(Pedicap® Nellcor)
Mal position / accidental dislodgement of endotracheal tube 15,16,17,18 Confirm position on chest x-ray - ETT should be at T2 -T3
Secure the ETT with correct taping at nares / mouth with correct alignment of
tube and circuit
Document position of ETT and confirm position at beginning of each shift and
after handling
Measure length of ETT from lips / nares to suction port after handling or suction
Avoid over extension of the neck and ensure body position is correctly aligned
and well supported
Avoid excessive drag on the ETT which may cause dislodgement – ensure the
circuit is secured
Provide adequate sedation if infant is restless.
Watch for symmetrical chest movement and listen to the quality of breath sounds
Ensure alarms on ventilator & humidification are set appropriately

Individualise suction to keep ETT free of secretions and mucous

Occlusion of endotracheal tube 16,17,18,19,20 Observe chest expansion and oxygenation after surfactant administration
Provide delivery of pre warmed, humidified gas to prevent tenacious secretions
and mucus plugging
Prevent excessive rainout by insulating circuit (preferred) or decreasing humidity
Ensure ETT tube is not kinked and the circuit is correctly supported
Ensure alarms are set appropriately
Use pulmonary mechanic monitoring to observe for asymmetry of volume graphs

This is best avoided by ensuring an appropriately sized endo tracheal tube at

Leak around endotracheal tube 16,17,20 intubation
Observe for leak at beginning of shift or after handling
Report leak and possible compromise of ventilation
Sudden leak may mean ETT has been accidentally dislodged
Re intubation may be required if ventilation compromised

RPA Newborn Care Clinical Practice Guidelines

Main author: Ms Maria Daco CNS July 2009, revised December 2010, revised July 2011
Review July 2012
 Check ventilator circuit, that is inspiratory & expiratory limbs are correctly
Ventilator connections or circuit complications 16,17,19,20 attached at beginning of shift and after nitric oxide is added
Ensure humidifier is turned on and set at target temperature
Avoid excessive rainout but observe misting in ETT
Ensure ventilator and humidification alarms are appropriately set
Ventilator circuit should connect with ETT on the flat – circuit should never be
above the ETT

Ensure proper hand washing by all care-givers

Infection 16,18 Individualise oral & lower airway suction to prevent excessive secretions and
mucous plugging
Frequent change in body position to prevent pooling of secretions
Careful intra gastric feeding – early recognition of feed intolerance
Provide frequent oral hygiene using sterile water
Prevent excessive rainout in circuit
Use sterile water in humidifier
Change ventilator tubing every 7 days
Frequently inspect nares / mouth during oral hygiene for pressure or other trauma
Airway and Lung Injury including prevention of barotrauma / volutrauma & from ETT / suction
pneumothorax 15,16,17,18,19,20,21,22 Ensure ETT is secured without pressure on nares or lips
Deliver pre-warmed, humidified gas to prevent airway injury
Plan extubation as soon as infant’s condition permits.

Avoid excessive PIP – avoid over ventilation. Maintain TV ≈ 3-4mls / kg

Do not drive CO 2 too low – discuss target levels with duty neonatologist / fellow
Initiate prompt changes to ventilation with improvement to lung compliance after
surfactant – set alarms appropriately
Manage un synchronised ventilation using sedation / position techniques
Reduce sensitivity setting in larger more mature infants
Prevent rainout using insulation of circuit (preferred) or reducing humidification
Ensure misting is observed in ETT and proximal circuit
Perform arterial blood gases frequently to facilitate weaning / optimise
ventilation

RPA Newborn Care Clinical Practice Guidelines

Main author: Ms Maria Daco CNS July 2009, revised December 2010, revised July 2011
Review July 2012
Long term complications Target oxygen levels appropriate to gestation, post natal age and condition on
Retinopathy of Prematurity 23 infant to prevent hyper oxygenation
Calibrate and set alarms on oxygen analyser
Only attach blended air / oxygen to anaesthetic bags & Neopuff®
Set alarms on all ventilators and all devices used to monitor oxygenation

Chronic Lung Disease 24,25 Prevent airway damage through good nursing management and attention to detail
as described above

Prevention of preterm birth

Cerebral palsy 26 Prevention of nosocomial infections

Preterm infant < 37 weeks Target Oxygen Alarm limits

Infant in air SpO 2 % Target greater than 90% 88-100%

Infant in oxygen SpO 2 % 90 -95% 88-96%

Transcutaneous TcO 2 mmHg 50-60 mmHg 45-70 mmHg
Transcutaneous TcCO 2 mmHg 45-55 mmHg 40-60 mmHg

Term infant Target Oxygen Alarm limits

Infant in air SpO 2 % Target greater than 95% 88-100%

Infant in oxygen SpO 2 % 92-98% 91-99%

Transcutaneous TcO 2 mmHg 60 – 80 mmHg 50- 90 mmHg
For the term infant with Persistent Pulmonary Hypertension of the Newborn (PPHN) then discuss target
oxygen and alarm limits with staff specialist & document on NICU chart. Modify target oxygen only after
discussion with staff specialist / Fellow.
Transcutaneous TcCO 2 mmHg 45-55 mmHg 40-60 mmHg

RPA Newborn Care Clinical Practice Guidelines

Main author: Ms Maria Daco CNS July 2009, revised December 2010, revised July 2011
Review July 2012
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RPA Newborn Care Clinical Practice Guidelines

Main author: Ms Maria Daco CNS July 2009, revised December 2010, revised July 2011
Review July 2012