When a child stops breathing, quick and effective ventilation is crucial to saving their life. In such moments, knowing the right way to provide breaths and how often to do so can make all the difference. Whether you are a healthcare professional or a layperson, understanding the proper ventilation rate and technique is key to ensuring the best possible outcome for the child. In this blog, we’ll explore the correct ventilation rate for pediatric patients in respiratory arrest, the techniques for delivering effective ventilations, and the tools you can use to ensure you’re providing the best care in an emergency.
What is Respiratory Arrest in Pediatrics?
Respiratory arrest in pediatric patients occurs when a child is unable to breathe or stops breathing altogether. This can happen suddenly and is often a life-threatening emergency. It can be caused by a variety of factors, including:
Obstruction in the airway: This could be caused by choking on food or small objects or swelling due to an allergic reaction or infection.
Medical conditions: Respiratory arrest can result from severe asthma attacks, pneumonia, neurological disorders like seizures, or other respiratory illnesses.
Trauma or drowning: Accidents such as head injuries or near-drowning incidents can quickly lead to respiratory arrest in children
Signs of Respiratory Arrest in Children
The signs of respiratory arrest in children include:
- The Absence of normal breathing
- Cyanosis(bluish skin, especially around the lips or fingertips)
- A weak or absent pulse
The Recommended Ventilation Rate for Pediatric Patients
For a pediatric patient in respiratory arrest who still has a pulse, it is important to provide ventilations at the correct rate to ensure they receive enough oxygen. The correct ventilation rate for a pediatric patient in respiratory arrest is to:
- Provide 1 breath every 2–3 seconds, which equals 20–30 breaths per minute.
This rate helps maintain oxygen levels without over-ventilating the child, which can cause issues like gastric inflation (air entering the stomach instead of the lungs) or reduced blood flow. If the child is in cardiac arrest (no pulse), the approach changes slightly:
- Perform CPR with a compression-to-ventilation ratio of 30:2 for a single rescuer.
- For two rescuers, the ratio is 15:2.
In both cases, delivering the correct number of compressions and breaths is important for maintaining circulation and oxygenation until advanced medical help arrives.
How to Deliver Effective Ventilation?
Ventilation is important to restore oxygen in the body. Below are the steps for proper technique and the tools you can use to ensure ventilations are performed correctly:
Proper Technique and Positioning
- Position the Airway: To open the airway, use the head-tilt, chin-lift technique. This method helps to clear the airway for breathing. If you suspect a spinal injury, do not tilt the head. Instead, use the jaw-thrust maneuver to keep the neck stable while opening the airway.
- Seal the Airway: Whether you’re using mouth-to-mouth or a bag-valve mask (BVM), make sure to create a tight seal to prevent air from escaping. This ensures the air is delivered directly to the lungs.
- Delivering the Breath: Give each breath over 1 second, making sure to watch for the chest to rise. This is a clear sign that the air is entering the lungs and oxygenating the body.
Tools: Bag-Valve Mask and Airway Devices
- Bag-Valve Mask (BVM): The Bag-Valve Mask(BVM) is a critical tool used in emergencies to provide breath. It allows controlled ventilation, delivering air into the lungs. Be sure to maintain a tight seal with the mask to prevent any air from leaking out. A secure seal ensures the effectiveness of each breath given.
- Advanced Airway Devices: In more advanced care settings, healthcare providers may use endotracheal tubes or supraglottic airways. These devices bypass upper airway obstructions and provide a direct path to the lungs, making ventilation more effective, especially when there are complications like swelling or severe obstructions.
What are the Signs of Effective Ventilation?
When providing ventilations during pediatric respiratory arrest, it’s important to confirm that the breaths are being delivered effectively. Here’s how to know:
1. Visible Chest Rise
The chest should rise with each breath. This indicates that air is entering the lungs properly.
2. Improved Oxygen levels
If you’are able to monitor oxygen levels, an increase in oxygen saturation shows that the lungs are getting the necessary oxygen.
3. Stable or Improving Pulse
A pulse that stays steady or improves suggests that oxygen is being delivered to vital organs like the heart and brain.
4. No Excessive Ventilation
Avoid overventilating (giving too much air), as this can cause issues like gastric inflation, which can lead to complications.
Ventilation Rate in the Context of Pediatric CPR
The ventilation rate changes slightly depending on whether or not an advanced airway is in place:
Without an Advanced Airway
For CPR, follow the compression-to-ventilation ratio:
- 30:2 (30 chest compressions to 2 breaths) for a single rescuer.
- 15:2 for two rescuers.
With an Advanced Airway
If an advanced airway like an endotracheal tube is in place, the chest compressions are continuous, and ventilations are asynchronous (not timed with compressions):
- Provide 1 breath every 6 seconds, which equals about 10 breaths per minute.
Common Challenges and How to Overcome Them in Pediatric Respiratory Arrest
Pediatric respiratory arrest is life-threatening, and you might face some challenges while giving proper ventilation. Here are the problems you may face and how to overcome them:
1. Difficulty Achieving Chest Rise
If the chest isn’t rising with each breath:
- Reposition the airway to ensure it’s open.
- If you’re using a Bag-Valve Mask (BVM), check the mask seal to make sure it’s tight enough to avoid air leakage.
2. Airway Obstructions
If the airway is blocked by mucus, vomit, or other obstructions:
- Suction any secretions out of the airway.
- Use an appropriate-sized airway adjunct, such as an oropharyngeal or nasopharyngeal airway, to help keep the airway open.
3. Maintaining Consistency in Ventilation
Delivering ventilations too fast or too slow can cause issues like hyperventilation (too much air), which is harmful. To stay on track:
- Monitor the ventilation rate closely.
- Use a metronome or another timing device to ensure accurate and steady breaths.
Conclusion
You must provide the correct ventilation rate to manage pediatric patients in respiratory arrest. It ensures the child gets enough oxygen to their organs, reduces complications, and helps keep their heart and brain functioning while you await further help. Healthcare providers and first responders must stay updated on the latest guidelines and practice the right techniques to confidently handle these emergencies. With proper techniques and staying calm under pressure, you can improve the chances of recovery for a pediatric patient in need.
By joining CPR classes or PALS certification courses at Heart Start CPR, you’ll learn essential techniques needed to provide life-saving care. Stay prepared and ready to make a difference when it matters most.
