ECMO-/ECLS

C. Choosing Initial Settings (for PC, VC and PRVC):
First choose a mode based on the desired triggering mechanism (mandatory
breaths, support breaths or combination like e.g. SIMV), and the desired way of
controlling/limiting for the delivered breath size (PC, VC, or PRVC)
Then the dealer’s choices are:
FiO2: start at 1.0 (100%) and decrease to the lowest level needed to accomplish
adequate oxygenation. To avoid or minimize oxygen toxicity, the clinician/operator
should manipulate other settings (see oxygenation below) in order to achieve
adequate oxygenation with a FiO2 that is less or equal to 0.6 (60%).
RR: start with a RR that is somewhat normal for the child’s age (e.g. infants and
small children 20-30, adolescent 15. Keep in mind that the higher the RR the less
the exhalation time.
Inspiratory time (iT): Generally, also age dependent, shorter in infant-small children
(0.4-0.7 seconds) than in adolescents (0.8-1). Increasing inspiratory time improves
oxygenation, but causes a concomitant decrease in the expiratory phase which
may be detrimental for CO2 elimination.
PEEP (positive end expiratory pressure): Setting the PEEP regulates the
pressure at the end of the respiratory limb and this is a mechanism to control the
patient’s functional residual capacity (FRC). The goal should be to maintain FRC >
closing capacity (volume at which smallest start to collapse). PEEP should rarely
be set below 4-5 (good starting point) and could be titrated up based on the oxygen