Oxygen modalities

Question 1

Indications and Set up for N/C

Answer 1

¼-2 Lpm (infant) (Remember not to Occlude the Nares – about ½ only)

Use to treat patients recovering from Chronic lung disease

Question 2

What are the indications for HFNC.
What are the liter flows for HFNC
What is HFNC able to do?

Answer 2

o Indications:
 Alternative form of O2 support for apenic neonates
o 1-20 LPM
o For oxygenation: Possible Peep like effect maybe 2 cmH20
o Ability to Washout Anatomic Deadspace

Question 3

What are the indications for CPAP (Bubble or Nasal)

4 indications

Answer 3

•	Bubble CPAP or Nasal CPAP
o	Indications:
	Apnea of Prematurity
	Premie with Minimal RDS after delivery
	After intubation with surfactant administration
	RDS after extubation

Question 4

What are the indications for intubation for neonates and peds?
6 indications

Answer 4

o	On CPAP with Pa02 <50 with Fi02 >60
o	Frequent apnea despite being on CPAP and medcations
o	Prolonged apnea events
o	Deteriorating gas exchange
o	Administration of surfactant
o	 General Anesthesia

Question 5

Indications for Airway clearance Therapies

Answer 5

Inability to clear own secretions
o Acute Lobar Atalectasis Secondary to Mucous Plugging

o CF
 (No one modality is superior to the other, Choose what works best with the patient except when GERD is an issue)

o NMD
 Hyperinflation Therapy
 Cough Assist
 IPV

o Lung Abscess

Question 6

What are contraindications to airway clearance therapies?

Answer 6

• Hemopysis
• Untreated Tension Pneumo
• Empyema and large plural effusions
• Foreign Body Aspiration
• Hemodynamiclly Unstable
• Fresh Trach
• Neonates with weak ribs

Question 7

Complications and Hazards to Airway clearance therapy

Answer 7

• Hypoxemia
o Position Changes
o Percussion leading changes in mucous positions altering gas exchange
o Atelectasis pushing out of FRC or causing large pressure changes in the lungs
o Bronchospasm
o Increased O2 consumption
o GERD

• Airway Obstruction from foreign body entering the lungs
• Intracranial Complications/ IVH in newborns
• Rib Fracturing and Bruising
• Airway Trauma

Question 8

Selection Criteria for ECMO UCSF

Answer 8

•	UCSF selection criteria for ECMO
o	Gestational age >34 weeks
o	Weight >1.8 kg
o	Reversible disease
o	Vent <14 days
o	Failure of Maximal medical management
o	Predicted mortality of >80% by historical criteria

Question 9

Exclusion criteria for ECMO UCSF

Answer 9

•	Exclusion criteria
o	Major intracranial Hemorage
o	Lethal malformation
o	Uncontrollable Coagulapathy
o	Syndrome with poor prognosis
o	Severe neurological injury

Question 10

Clinical Indications for ECMO UCSF

Answer 10

• Clinical indications for ECMO

o Oxygen index 40 or greater in 2 or more ABG’s
o Intractable metabolic acidosis
o Intractable shock
-Progressive, intractable pulmonary or cardiac failure
-Inability to come off cardiopulmonary bypass at operation