Respiratory

Question 1

What are the typical frequency settings for the HFOV for term vs preterm babies?

Answer 1

Term and larger babies: 10
Preterm: 12-15

Be cautious about Hz <10: most centers don’t go this low due to manufacturer recommended settings

Remember: higher Hz results in lower tidal volumes

Question 2

When should you (in terms of infant’s day of life) start giving dex for lung disease?

Answer 2

Day 8

“‘Make a date with dex on day 8”

Question 3

What is the definition of BPD?

Answer 3

<32 wga with an ongoing need for supplemental oxygen and/or respiratory support at either 28 days postnatal age or 36 weeks postmenstrual age (PMA), with radiographic evidence of parenchymal lung disease

Question 4

When is severity of BPD determined? What are the definitions of mild, moderate, and severe?

Answer 4

Severity assigned at 36wk PMA (or discharge home, whichever occurs first):

Mild: Breathing room air 

Moderate: Physiological need for <30% fiO2 

Severe: Physiological need for ≥30% fiO2 or positive pressure (any support ≥2L/min flow)

Question 5

What is the typical starting MAP on the HFOV?

Answer 5

If you need to recruit: 2-3 above the MAP on the conventional ventilator. If you need to minimize lung trauma, set MAP equal to MAP on CMV.

If needing to recruit and MAP is already in 20’s on the CMV, start around 20 on the HFOV then adjust (don’t start a MAP higher than 25).

Question 6

What is the typical starting power on the HFOV?

Answer 6

2.5, adjust for optimal bounce

Question 7

When do you start weaning settings on the HFOV and what do you typically wean?

Answer 7

Wean the power based on CO2

Wean the MAP once FiO2 is <40% unless there is over inflation or cardiac compromise