If an endotracheal tube is placed, then mechanical ventilation should soon be instituted. Determining appropriate initial settings for the mechanical ventilation of children can be difficult. For children weighing less than 10 kg, time-flow or pressure preset ventilators should be used. For time-flow ventilators, inspiratory and
expiratory times are needed. Typical inspiratory times are 2 to 1 s, depending on ventilation frequency. For pressure ventilators, inflating pressures are determined by using pressures necessary to inflate the lungs and cause the chest to rise. Pressures usually range from 15 to 40 mmHg. Excess pressures can cause barotrauma. For older children, volume ventilators can be used, starting with a tidal volume of 10 mL/kg, as for adults. If the lungs have normal compliance and the child does not
require hyperventilation, then the respiratory rate should be started at 2 the normal rate for age (20 breaths/min for infants, 15 breaths/min for young children, and 10 breaths/min for older children and adolescents). Children should be adequately sedated and paralyzed during mechanical ventilation until definitive care is started in a pediatric intensive care unit.
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