LIBRO + ANEXOS NEUMOLOGÍA PEDIÁTRICA

Neumología Pediátrica. Anexos ❚ 197 tracheostomy tubes in patients receiving positive pressure ventilation via tracheostomy tube 5. Know that mucous plugging of tracheostomies is common, and patients should be monitored with appropriate alarm systems to detect tracheostomy plugging and/or decannulation during positive pressure ventilation via the tracheostomy 6. Know that high pressure alarms are used to detect tracheostomy plugs but that they will not sound if a ventilator is used in a pressure control mode during positive pressure ventilation via tracheostomy 7. Know that low pressure alarms are used to detect a ventilator circuit disconnect or a tracheostomy decannulation during positive pressure ventilation via tracheostomy tube d. Bi-level positive pressure ventilation by mask or nasal prongs 1. Know that during bi-level positive airway pressure ventilation by mask or nasal prongs baseline expiratory positive pressure (E-PAP) with inspiratory positive airway pressure (I-PAP) are delivered to assist a child's spontaneous breathing 2. Know that bi-level positive pressure ventilation is delivered via a nasal mask, facemask, or nasal prongs, so a tracheostomy is not required 3. Know that the different modes of bi-level positive pressure ventilation include spontaneous, timed, spontaneous/timed, and continuous positive airway pressure (CPAP) 4. Know that during bi-level positive pressure ventilation tidal volume is proportional to the I-PAP minus E-PAP difference 5. Know that bi-level positive pressure ventilation is most commonly used for children requiring ventilation only at night 6. Know that the complications of bi-level positive pressure ventilation are most frequently related to the facemask e. Negative pressure ventilation 1. Know that during negative pressure ventilation, ventilation is caused by negative inspiratory pressure applied to the outside of the chest and upper abdomen, so a tracheostomy is not required 2. Know that during negative pressure ventilation adequate ventilation depends on the ability to expand the chest with negative pressure applied outside the chest, making negative pressure ventilation less effective when chest wall motion is restricted 3. Know that upper airway obstruction can occur with negative pressure ventilation f. Diaphragm pacing 1. Know that diaphragm pacing requires surgical implantation of phrenic nerve electrodes and receivers 2. Know that diaphragm pacing is contraindicated in patients with damage to the phrenic nerve (motor neuropathies or trauma) or primary myopathy of the diaphragm 3. Know that diaphragm pacing is most commonly used for children with congenital central hypoventilation syndrome, other central hypoventilation syndromes, and high spinal cord injury (C1-2)