Algorithms Flashcards
Primary CPAP Management in the Delivery Room
GA 26-28 Weeks
What are your first steps
Clear airway
Initiate CPAP +5, FiO2 0.30
Stimulate
Attach pulse ox
Primary CPAP Management in the Delivery Room
GA 26-28 Weeks
What second steps
Assess for spontaneous breathing
Yes-Move on to HR assessment
No-Initiate Neopuff and NRP
Primary CPAP Management in the Delivery Room
GA 26-28 Weeks
You just assessed that the patient is spontaneously breathing
Assess that heart rate
If above 100-Move on to next assessment
If below 100-Begin neopuff and NRP
Primary CPAP Management in the Delivery Room
GA 26-28 Weeks
You just assessed that the patient’s heart rate, what do you assess next
Assess WOB and SpO2
Mild WOB and SpO2 within range- Maintain CPAP at +5 and FiO2 at 0.30 and prepare to move to NICU
Moderate or Severe WOB and/or SpO2 not within range- Increase CPAP by 1 (Max 6) and increase FiO2 by 0.10-0.20 to achieve targeted SpO2. Then reass WOB and SpO2 if now mild WOB and SpO2 then mainatin level and move to NICU.
If after you make your changes and then FiO2 is >0.60 or there is severe WOB then consider intubation
Primary CPAP Management in the Delivery Room
GA 26-28 Weeks
Principals
Maintain optimum lung volume and FRC in order to avoid derecruitment and over distention
In L&D and acute phase avoid CPAP >6 in infants 26-28 weeks
Infants 28 weeks or less will need ot be intubated by a senior practictioner
Early surfactant does not mean immediate surfactant rather surfactant should be administers in NICU when possible
Primary CPAP Management in the Delivery Room
GA 26-28 Weeks
Important Aspects
For preterm infants (>29 weeks) follow NRP algorithm
When using Neopuff or flow inflating bag pay attention to INSPIRTORY TIME
When providing PPV count out loud breath, two, three and occulde PEEP only when you say breath in order to avoid prolonged Ti
Avoid doing other tasks when prviding PPV
If HR is < 60 ensure adequate ventilatioation and start chest compression according to NRP
Intubation could be performed at any point at te discertion of the team leader
Primary CPAP Management in the NICU
GA 26-28 Weeks
First Steps
Upon admission to NICU start nCPAP at the same level needed in L&D
Load with caffine ASAP
Do a CXR and blood gas
Primary CPAP Management in the NICU
GA 26-28 Weeks
CXR and Blood Gas
Pneumothorax-Discontinued CPAP, intubate, early surfactant, drain pneumothorax as indicated
Hypoinflation: Consider increasing CPAP or consider intubation, and early surfactant
Hypercarbia (arterial): Consider incresing CPAP
Primary CPAP Management in the NICU
GA 26-28 Weeks
Second Steps
Assess WOB and SpO2
Severe WOB
Moderate WOB or FiO2>0.30
Moderate WOB AND FiO2>0.30
Primary CPAP Management in the NICU
GA 26-28 Weeks
Severe WOB
Assess interface fit and seal, assess the need for suction if all of those do not work consider intubation, CXR, early surfactant
Primary CPAP Management in the NICU
GA 26-28 Weeks
Moderate WOB OR FiO2 >0.3
Assess interface fit and seal
Assess need for suctioning
Review with dr consider CXR and blood gas
Increase CPAP by 1 with a max CPAP of 6
Primary CPAP Management in the NICU
GA 26-28 Weeks
Consider intubation with
Severe WOB: After you have assessed for interface seal and suction needs
FiO2 >= 0.30 OR
pH <7.20
PaCO2 >55mmHg
Primary CPAP Management in the NICU
GA 26-28 Weeks
Mild WOB and FiO2 <0.30
Leave CPAP at same level until able to maintain target SpO2 with FiO2 <0.25
SpO2 >92% for 6.24 hours AND FiO2 <0.25 (if no review with dr and increase CPAP). If yes then review histogram
Primary CPAP Management in the NICU
GA 26-28 Weeks
Review histogram
SpO2 >85% for 80% of the time and no significant apneas
No-Optimize CPAP for 2-5 days and optimize caffeine
Yes-Wean CPAP by 1
Primary CPAP Management in the NICU
GA 26-28 Weeks
Wean CPAP by 1
CPAP = 4 AND FiO2 < 0.25
YES-SpO2 >85% for 80% of the time and there is no significant apneas then you can discontinue CPAP (then you can discontinue CPAP and start NP at 0.5 lpm)
No: Review whether SpO2 >92% for 6-24 hr and FiO2 <0.25
