Quick Start Guide - 4 Steps

1. Select Starting Settings

JET RATE
  • Start with 420 bpm.
  • Start lower if patient is larger than 1 kg or is suffering from lung conditions that may cause gas trapping.
  • Selecting rates in multiples of 60 bpm (1 Hz) is convenient.

JET PIP
  • Start with PIP equal to or a few cm H2O less than that currently being employed by CMV (or HFOV, as revealed by pre-HFJV monitoring with the Jet in standby mode).

Jet I-Time
  • Start with default setting of 0.020 sec.

CMV PEEP
  • Raise PEEP by 2 cm H2O when transitioning from CMV in order to preserve MAP and lung volume.
  • Adjust PEEP as necessary to maintain same or slightly lower MAP when transitioning from HFOV.

CMV Rate
  • Start with 5 bpm (eliminating them in Step 3 will help determine optimal PEEP).

CMV PIP
  • Keep current CMV PIP setting or reduce by 10-50% if concerned about lung injury.
  • If transitioning from HFOV, set CMV PIP a few cm H2O below HFJV PIP. 

CMV I-Time
  • Keep current CMV setting or set at ~ 0.4 sec or less if transitioning from HFOV.
2. Fine-Tune Ventilation

Adjust HFJV PIP
  • Raise or lower HFJV PIP as necessary to decrease or increase PaCO2 respectively.
  • HFJV PIP is less hazardous than CMV PIP because of the smaller size and shorter duration of tidal volumes produced by HFJV vs. CMV PIP settings.

Adjust HFJV Rate
  • Increase Rate to reduce PaCO2 if patient is preterm with no evidence of gas trapping.
  • Decrease Rate if gas trapping is a possibility as indicated by inadvertent PEEP or pulmonary hyperinflation on chest xray. (Suggested change = 60 bpm, 1 Hz.)

Call Bunnell Hotline
  • If necessary.
  • Bunnell clinical specialists have years of experience helping people troubleshoot and ventilate challenging patients.
3. Find Optimal PEEP

Use CMV to help find optimal PEEP
  • Fine tune FIO2 to establish pulse oximetry ~ 90%.
  • Wait for stabilization of pulse oximetry reading if possible, then switch CMV to CPAP or as close to CPAP mode as possible without triggering CMV apnea alarms (i.e., reduce CMV Rate, PIP, and I-Time as much as possible).
  • If oximetry reading drifts downward over the next few minutes, increase PEEP by 1-2 cm H2O. (Give a few manual CMV breaths if necessary to re-recruit alveoli that collapsed in the interim.)
  • Continue increasing PEEP, while alternately switching back to CMV at 5 bpm if necessary, until oximetry reading re-stabilizes.
  • Reduce FIO2 as necessary to re-establish oximetry ~ 90%.
  • You have achieved optimal PEEP once you can switch to CPAP without a reduction in SaO2.
4. Evaluate Response

ABG & SERVO PRESSURE
  • Establish baseline relationship between good arterial blood gases and Servo Pressure.
  • Significant changes in Servo Pressure indicate changes in patient status or potential problems, such as the need for suctioning, weaning, etc