Mechanical Ventilation/Oxygen Administration:Neonate

Question 1

What are the 4 goals of nasal CPAP?

Answer 1

Increase FRC, increase compliance, decrease airway resistance, and decrease rr

Question 2

Mechanical ventilation is needed when CPAP greater than __ cmH2O is needed, and clinical signs of exhaustion from exhaling against the pressure.

Answer 2

10

Question 3

When using CPAP, keep the PaO2 between __ and __mmHg. Keep PaCO2 less than __ to __. Keep the pH atleast __.

Answer 3

50-70, 50-55, and 7.25

Question 4

List some indications for mechanical ventilation in an infant.

Answer 4

PaCO2 greater than 55mmHg
PaO2 less than 50 mmHg on 50% O2 and maximum CPAP of 10.
Grunting, flaring, retractions on CPAP
Cyanosis and agitation on CPAP

Question 5

List some neurological conditions that may require the usage of mechanical ventilation in an infant.

Hint: “Danny Ate In Comfort”

Answer 5

Drug depression
Apnea periods leading to bradycardia and hypoxemia
Intercranial hemorrhage
Complete apnea

Question 6

List some pulmonary conditions that may require mechanical ventilation.

Hint: “My Dog Isabell, Can’t Play Dead.”

Answer 6

Meconium aspiration syndrome(MAS)
Diaphragmatic hernia
IRDS
Cyanosis heart defects
Pulmonary edema
Diffuse pneumonia

Question 7

List the following initial vent settings. Assume the patient has NORMAL lungs.
PIP, frequency, I:E, I-Time, E-time, PEEP, flow, FiO2

Answer 7

PIP: 12-18H2O
Frequency: 20(up to 40)
I-time: at least 0.4s
E-time: at least 0.5s
PEEP: 3-5 or 4-5cmH2O
Flow: to see chest move and heat breath sounds generally 6-8 or more
FiO2: 40% to keep baby pink

Question 8

Which of the following oxygen administration equipment delivers a precise FiO2?

Answer 8

An oxyhood

Question 9

With an isolette an adjustable control provides alteration in the entrainment ports. When these ports are opened and oxygen is entering the unit, an FiO2 of what is achieved?

Answer 9

40%

Question 10

T or F?
An isolette allows for a precise FiO2.

Answer 10

False. This system does NOT allow specific FiO2 levels to be consistently delivered.

Question 11

The minimum liter flow into the oxyhood of __L/M is required to prevent the rebreathing of exhaled CO2

Answer 11

7

Question 12

What is an isolette generally used for?

Answer 12

It is used for thermal control. Temperature is monitored and maintained with skin probe attached to newborn.

Question 13

List a few disadvantages of an isolette.

Answer 13

Unable to maintain a stable FiO2, risk of infection, and reduced relative humidity.

Question 14

What is a radiant warmer?

Answer 14

A radiant warmer is a type of equipment that used an open bed system that provides infrared heat from an overhead source.

Question 15

What temp. should a neonate’s skin be maintained?

Answer 15

Between 35•C and 37•C

Question 16

A newborn that is hypothermic will increase oxygen consumption and develop what three things?

Answer 16

Hypoxia, hypoglycemia, and periods of apnea

Question 17

If the infant is not responding to CPAP what should be the next intervention?

Answer 17

Intubation

Question 18

While using CPAP on an infant, what range should we aim to keep PaCO2?

Answer 18

Less than 50-55 mm Hg

Question 19

While using CPAP on an infant, what range should we aim to keep PaO2?

Answer 19

50-70 mm Hg

Question 20

List some contraindications of CPAP with an infant.

Answer 20

Prolonged apnea that has led to hypoxemia and hypotension, untreated pneumothorax, unstable cardiovascular status, and untreated CDH

Question 21

T or F?
CPAP can be used on an infant with cleft palate, TE fistula, and China atresia.

Answer 21

False