Ventilator settings made EASY - Ventilator 101 Part 2 - Tala Talks NICU

In part I you learnt PIP, PEEP, rate, and compliance. Now let's apply those to the ventilator- in addition to I time (Time) and pressure support. Learn which (and why) parameters change oxygenation and ventilation. If you get this lecture, you'll be well on your way to understanding gases.
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Dr. Tala is a board-certified neonatologist, and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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Pager-Brown, A. (2020). Neonatal resuscitation for ems providers. VDH Virginia. Retrieved from www.vdh.virgin...
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Music: www.bensound.com (royalty free with credit)
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently, this video should not be a replacement for medical advice.

[@saifaljuaid210]

Okay. This has been by FAR the most helpful video I’ve seen on mechanical ventilation m. Please do continue. Also, if I may suggest a topic, BPD is still a difficult one to grasp and there isn’t a lot of “simplified” content out there to help. Thank you for everything. Looking forward to seeing more!

[@TalaTalksNICU]

Thank you Saif- we really appreciate your words. BPD is an excellent idea- we will get around to it soon! Thank you so much for watching and commenting.

[@karlieramos1967]

Absolutely love these videos. As a nurse new to the NICU, these are the perfect tool to understand new concepts. The way you explain things is a gift. Thank you Dr. Tala for your time recording these!

[@TalaTalksNICU]

Thank YOU so much Karlie!!! First congratulations on your new role, hopefully you'll love it as much as we do! That's really great that you're digging for information yourself and remaining committed to learning. We're SO happy that these are helping. Let us know if you think of any topics you'd love to hear about- we have a bit of a back-log at the moment- but next big topic we're getting to is fluids and electrolytes (starting with very general info) as well as BPD. Again, thank you!

[@shardhasamaroo5610]

I love when it all finally makes sense! Thank you so much for these videos they are amazing. I would love to discuss other modes of oxygenation and ventilation and when it is appropriate to switch from like (HFOV to vent to CPAP)/ for vents when to use which ones and why, and maybe running through maybe specific scenarios/situations (just ideas). Thanks again.

[@TalaTalksNICU]

Thank you for your kind words and excellent suggestions. We are putting out a blood gas series now and then well get back to more specifics. (I definitely want to shoot a HFOV soon- as I love the theories behind all that!) Thank you again!

[@bincymathews1784]

Thank you so much Dr.Tala❤u r an inspiration to many of us

[@TalaTalksNICU]

What a lovely comment! Thanks so much for watching and taking the time to comment :)

[@amykim994]

This was so helpful, thank you! I'm 10 months into working at a level4 NICU and the vent settings were always so confusing! I'd love to see a video going in depth on vent modes such as CMV, P-SIMV, APV/SIMV!

[@TalaTalksNICU]

Hello! We're so glad you found these helpful! We have been wondering how to do this for ages- but we think we may have found a solution- we just need an RT to help us! ha! So we promise we'll get it out eventually!!! Thanks again for being here :)

[@ThanhNguyen-xm4hp]

I'm a neonatal nurse, love your videos.Can you talk about NC HFNC CPAP and NIPPV? it’s all critical information! Thank you

[@TalaTalksNICU]

Hello! Thanks so much for being here!!! We made one video on HFNC (maybe search for it on the home page) and we’re planning on covering Cpap and NIPPV soon!!! Actually my Cpap script has been half written for a year! Need to get on that! Thank you!!!

[@vickiewinner5739]

THANK YOU! I'm an NNP student and this was SO helpful

[@TalaTalksNICU]

Vickie- that has made our day! So happy it helped. hope you enjoy the rest of your studies- it's a great field!

[@dabsminivlogs4742]

As a respiratory therapist assigned in nicu , still i was able to learn something 😉 love this channel ..

[@TalaTalksNICU]

We're so happy to hear that!!!! Thanks so much for watching and giving us the positive feedback! And thanks for helping take care of the babies :)

[@Veronica-re3ik]

New NICU nurse here, I love your videos!!! You teach in way that is so very understandable! Thank you 😊

[@TalaTalksNICU]

Oh yay! Congratulations on your new role! We are so happy these videos are helping! Thank you for writing to us :)

[@Totube69]

I wish someone would have taught this during residency

[@TalaTalksNICU]

Ha! I still have stuff like that now! I wish I knew that a year ago!!! Thanks for watching !!! What field are you in now?

[@Totube69]

@@TalaTalksNICU I chose general pediatrics (outpatient)

[@lalaxo5869]

This was sooo helpful ish had my forst call in tje nicu and i wanted to cry. Keep the videos coming

[@TalaTalksNICU]

Congrats on finishing your first call! They all get better!!! We'll definitely keep them coming- thanks so much for watching!

[@worldforu5013]

This is called clarity in concepts.

[@TalaTalksNICU]

That's what we're aiming for! Thank you for watching :)

[@DRAmiraMohamed-ow2lk]

Thanks for your aimple illustration ❤

[@TalaTalksNICU]

So glad you found it simple- thanks for taking time to write!

[@manishatri4226]

Very easy to understand... really learnt a lot today only in these 2 videos ❤

[@TalaTalksNICU]

So glad they’re helping with your education!!! Thank you so much for taking the time to comment :)

[@harishreddy4574]

Superb...easily one of the best lectures on ventilation👏👏👏👏👏

[@TalaTalksNICU]

That’s a huge compliment! Thank you so much for watching and for taking the time to comment!

[@henrypaknotes]

Thank you so much for ur videos. Does help me a lot in the respiratory care in NICU. Physio from HK. Cheers! Looking forward to ur next videos. Thanks a lot!

[@TalaTalksNICU]

That's fantastic! Thanks so much for letting us know Henry :) We'll be doing a non-invasive series soon- let us know if there's something in particular which would help!!!

[@joiejosh8154]

I love all your videos! Pls keep posting😉 very helpful and well explained. KUDOS to you and your team. I AM HOOKED!😍

[@TalaTalksNICU]

Hello Joie Josh! What a lovely message to see- these literally keep us going! Thank you for watching for taking the time to comment :)

[@deebutler9813]

I am hooked too! Please keep them coming Tala. You and your team are helping to save so many babies lives by your education.

[@bestchildspecialistdr.vine7982]

Very well explained in a simplified way .

[@TalaTalksNICU]

Thank you so much Dr. Vineeta!

[@Valentino1028]

Thanks for saying that about us RT’s!!! Much appreciated!!!

[@TalaTalksNICU]

I mean- of course! We all work together as a team- and we all have our different areas of expertise! Very much appreciate all the times RTs have taught me something or suggested a better alternative way. Thank you!

[@Crnvr-np4vw]

Tq so much for your excellent video..help me a lot in nicu posting. Looking forward for part 3

[@TalaTalksNICU]

We're so happy to hear that! Thanks so much for watching and commenting :)

[@fewdaysmukupa588]

This is really helpful, thank you Dr.

[@TalaTalksNICU]

Thank you so much for watching :)

[@anitangqunge9531]

Very interesting and informative videos Dr Tala

[@TalaTalksNICU]

Thanks so much Anita, for watching and for taking the time to write us a comment!

[@keyravasquez5528]

Thank you so much for this!!! I have an EB too!

[@TalaTalksNICU]

You do????? I’m obsessed with them!!!

[@Englishinfewdays]

Excellent video with great explanation, really soo glad to see this video tq soo much🙂🙂

[@TalaTalksNICU]

So glad it helped- we're all about simplifying these topics :)

[@Englishinfewdays]

NICU Tala Talks 🙂 can u please make more videos on ventilator, it a request🙂

[@KayemKarihinga]

Woowwwwwwww. I never understood this until today

[@TalaTalksNICU]

Well that just made our day! So happy it helped!

[@PPN1942]

Thank u for the wonderful content, so much easier to understand vent settings now!

[@TalaTalksNICU]

We're so glad! That's exactly what we set out to do! Thank you so much!

[@PPN1942]

@@TalaTalksNICU Can you talk about neonatal blood gases? Capillary, venous, and arterial gases?

[@TalaTalksNICU]

Yes! Coming soon! A series of talks!

[@abelitasousa6053]

Excellent

[@TalaTalksNICU]

Thank you so much!!

[@emalou627]

LOVE your channel! Your videos are so helpful for understanding complex topics I've tried to get for years :) Can you do a video on HFOV and Jet ventilators, how they differ and when to switch?

[@TalaTalksNICU]

Hello Emily! Thanks so much for your lovely words! We have filmed a couple of videos already that we'll be putting out- but I promise the next one we film will be on high frequency ventilation - starting with oscillators. It takes much longer to make and edit these videos than we originally thought!! but we will get it to you eventually!! Thanks so much for watching!

[@kyleFed]

I second this!

[@lotenna]

This is literally the best and most understandable video on ventilators I have ever seen. Would have saved me a whole lot of headache if I saw this video two years ago😢. Thanks so much for what you do. Please are you planning on making more videos on vents?

[@TalaTalksNICU]

Wow- thank you Lotenna! Makes us so happy that this helped at all. My daughter and I just checked out your channel- you are a PHENOMENAL singer!! Those babies are lucky to have you- with your genuine, happy spirit :)

[@lotenna]

@@TalaTalksNICU awwww! Thank you so much for your kind words 🙏🏼

[@farmlifekyekyessimplelife1347]

Very useful information for us as NICU nurses....thank you so much Dr.Tala....kindly give us more information about the use of inhaled nitric oxide and more details about management of babies on cooling

[@TalaTalksNICU]

Hello! Thank you so much for writing to us! We covered a video on cooling therapy (you can probably find in the home page). Let us know if there are other aspects you wanted us to cover. And we're putting out an iNO video soon- we need to film it!

[@farmlifekyekyessimplelife1347]

@@TalaTalksNICU Thank you so much Dr Tala,all your videos are excellent and very useful Been a great help! Looking forward for more videos! God bless you always!

[@carlamagee1657]

excellent explanation! thank you.

[@TalaTalksNICU]

So glad it helped! Thanks for watching and commenting. we'll go over gases soon :)

[@havvasimsek6419]

Excellent video. Thank you

[@TalaTalksNICU]

We're so happy it helped! Thanks for watching and commenting

[@Samri3344]

You are awesome endeed.👏👏👏

[@TalaTalksNICU]

Thank you so much Kevin Durant!

[@maribelvilla9055]

I learned so much!! Can you please make a video explaining the different modes of ventilators? Thank you!

[@TalaTalksNICU]

Thank you Maribel! That makes us so happy. So like- different modes on a conventional vent (PS/ AC/ volume control etc.)? We can definitely do that!!! Thank you for watching and commenting!

[@ELITEBloody642]

Fabulous. I second a video about HFO and maybe jet ventilation please. Thank you

[@TalaTalksNICU]

Thank you so much Bettina! These comments keep us going! We are recording a series on high frequency ventilation (will likely be three videos).Look for them pretty soon! We've been inundated with requests but this has gotten moved to the top of the pile!! Thanks again for commenting!

[@prasads8482]

Good explanation

[@TalaTalksNICU]

THANK YOU Prasad! We're loving your positive reinforcement :)

[@sumathybalaji5252]

Nicely explained

[@TalaTalksNICU]

Thanks so much Sumathy :)

[@ismailmohamed8746]

hi Tala ,very informative videos ,thank you ,If possible we need to know ventilator settings specific for each disease like RDS or meconium aspiration ,thanks

[@TalaTalksNICU]

Hello! We're so glad you found this informative. You're absolutely right- we need to do a practical vent settings video. Excellent idea- we'll try to get around to that sooner rather than later. Thanks!!

[@nittynithu]

Thanks so much for this Tala! Could you please do a video on neonatal fluid balance and electrolyte disturbances

[@TalaTalksNICU]

Yes Devika! Thanks so much for sticking with us! We will definitely be running a series on this- starting with some generalities! Thank you so much for being here!

[@rajivjasrotia9328]

Thts was very informative Dr Tala... Can u pls describe different modes of ventilation...

[@TalaTalksNICU]

Hello Rajiv! Thank you- yes these will be coming soon! Thanks so much!

[@osamaalagamawy3891]

ما شاء اللة. بارك اللة فيكم

[@TalaTalksNICU]

You've watched these all now!!!!

[@PR-py6sn]

Great knowledgeable stuff again. Do u have these detailed information on CPAP as well. Abt it's pressure settings, how much oxygen ltr per minute, saturation.... bcs u mentioned all these in BPD video.. if not then pls make one

[@TalaTalksNICU]

Yes! We are planning a series- realistically it will be in a couple of months- covering NC HFNC CPAP and NIPPV. You’re right- it’s all critical information! Thank you

[@abbyjordan2158]

great video! if the baby is initiating less breaths than the amount on the machine then will they still get the set PEEP and PIP for each breath even though the baby is initiating some of the breaths? i know you said if the baby is initiating more breaths than the set rate the pressure support gives a little pressure instead of the set PIP & PEEP to help overcome the resistance of the breathing tube.

[@TalaTalksNICU]

Hello! The PEEP is always there- it never goes away- like CPAP in background. Then the PIP kicks in for the rate the machine is set up. If the rate is 30 and baby is breathing 20 times a minute, then and additional 10 will be given when the baby isn’t taking a breath. Does that make sense?

[@jeant9946]

Hi Tala..I just wanna add something to your amazing video...Despite it is true that TV will depend on PIP-PEEP. But it is not always like that... in Volume-Press loop, if we decrease the PEEP too low, it will not result in higher TV because the Compliance (C) is decreasing, hence lower TV. Feel free to correct me if I am wrong. Thanks.

[@TalaTalksNICU]

Hello Jean! You’re absolutely right- this is an excellent point- and maybe I didn’t emphasize this enough in the video. This is true if your pressures are super high too and your lungs are over inflated- increasing the PIP won’t change your tidal volume much either. Thank you!!

[@fewdaysmukupa588]

Dr please kindly teach on the pathophysiology of RDS.

[@TalaTalksNICU]

Hello! We recorded a video on RDS. You can search for it under the home page. Hopefully that has the information you are looking for- if not, then please let us know!

[@pinetinav9083]

I love you ❤

[@TalaTalksNICU]

Ha! I'm sure if we met, we'd share the sentiment!

[@brittneybeckett7534]

Can you do a video about BiVent settings?

[@TalaTalksNICU]

Hello- another great request- we're planning on doing a lecture and briefly discuss many of the settings. We're trying to figure out how to do it best!

[@moumitabiswas883]

Mam please explain leak compensation algorithm in Draeger VN 500?

[@TalaTalksNICU]

Hello! Yes! We need to do this in front of an actual machine- we are trying to figure out the logistics of this!

[@vonnynasr2278]

(Awww your furry friend). Very informative talk. Thank you

[@TalaTalksNICU]

Thank you for being our most loyal and dedicated viewer! We will find a prize for you! Ha

[@drnaumannaseer1941]

Kindly upload 3rd part... Waiting

[@TalaTalksNICU]

Hello Nauman! We had finished the standard vent talks- what were you hoping to see next? More information on ventilator modes or information about other ventilators? We will definitely be covering both of these!! Thank you so much for watching!

[@drreetanirwal8809]

Mam kindly make a video for ventilator graphics and it's interpretation..I will really appreciate if ABG analysis is also discussed for a baby on venti

[@TalaTalksNICU]

Thanks you Dr. Nirwal- graphics on a vent is a great topic. We are planning a series on blood gases- hoping to do an introductory video on gases and then follow with several examples. Watch for that soon- we have gotten behind with requests - so we'll have to ask for your patience. Thank you so much for watching and giving us suggestions. We're so appreciative!

[@doctormombaby4319]

waiting for part 3

[@TalaTalksNICU]

Hello! We promise we'll get there. We're hoping to do part three at the bedside with an actual vent so we can give examples easier. Thank you for your patience!

[@nabeelaaltaf5027]

Great video! I want to ask about the sedation of the baby. How much midazolam should be given? should it be stat dose or a continuous infusion?

[@TalaTalksNICU]

Hello Nabeela! The answer to dosage about any medication in neonates is preferably none- but if you really have to- the lowest amount needed for what you're trying to manage. If the patient is staying extremely agitated when they've just had surgery for gastroschsis or something - and you want them moving as little as possible then a drip may be warranted. (Or a really bad PPHN you're trying to keep off ECMO). But generally give around the clock doses or even better PRN if needed (e.g. infant being cooled and getting cold and agitated). Generally we give between 0.05-0.1mg/kg Q3-6hrs. Just remember- none of these drugs are well studies in neonates- so we really don't know about lasting effects. Hope this helps!!!!

[@meenasood1915]

Love u

[@TalaTalksNICU]

We love you too! Thanks :)

[@Nhi.and.Bi.]

Hi Dr Tala, Just wondering if you could clarify what it means for a baby to be "CPAPing" on a ventilator, and how to troubleshoot that? Thank you!

[@TalaTalksNICU]

Hello! I'm not totally sure in what context you're using it! Generally when I say CPAP on the vent- we're at SUCH low settings- whether it's the jet or the oscillator (or we're actually just giving CPAP but with an ETT in place) that it is actually CPAP. (Ie giving a PEEP and little else). Is this what you mean- or something else?

[@rasoulhoma8007]

👌👏

[@TalaTalksNICU]

Thank you (and thanks for subscribing :))

[@marimarrivera4643]

Is there a part 3?

[@TalaTalksNICU]

We’re trying to figure out how to do part three on the actual machines- coming relatively soon hopefully!!

[@therealcrystalhughes]

My daughter is 1 month old at NICU her ventilator is set at O2 conc. Is 24, Peep 6.0 SMIV rate 45 PC above PEEP 32 and PS above PEEP 6. Please help! I’m not sure but rate is to high I think.

[@TalaTalksNICU]

We replied below- good luck

[@thakorbhaivankar9838]

Excellent

[@TalaTalksNICU]

Hope was helpful! Thanks so much for being here :)

[@therealcrystalhughes]

My daughter is 1 month old at NICU her ventilator is set at O2 conc. Is 24, Peep 6.0 SMIV rate 45 PC above PEEP 32 and PS above PEEP 6. Please help! I’m not sure but rate is to high I think.

[@TalaTalksNICU]

Chrystal- we are really not allowed to give any direct medical advice (could cost us our licenses). Many different hospitals practice differently, so we would suggest asking more information from your daughter's medical team. Good luck- we wish her a rapid healing process.

[@therealcrystalhughes]

Thx