ventilation/resus

Question 1

when to use 100% O2 in resus

Answer 1

when HR <60
or HR not above 100 despite good IPPV
or HR good but O2 not right

Question 2

100% O2 cx

Answer 2

ROP
BPD
delayed onset of respiration

Question 3

term infant vs preterm infant - starting O2 in resus

Answer 3

term = 0
preterm = 30%

Question 4

apgar stands for

Answer 4

appearance = colour, oxygenation
pulse
grimace
activity
respiratory

Question 5

most sensitive indicator of resusc efficacy

Answer 5

HR

Question 6

neonatal resusc adrenaline strength vs anaphylaxis adrenaline

Answer 6

neonatal resusc: 1/10,000
anaphylaxis: 1/1000

Question 7

ideal position of UAC? why?

Answer 7

high position significantly less risks of clinical vascular
compromise and aortic thrombus formation.
T8-T10 (above diaphragm which is T12)

Question 8

biggest risk of UAC/UVC

Answer 8

Vascular embolisation, thrombosis, spasm
- clots in 95%, serious complications in 5%

Question 9

CPAP - insert what?

Answer 9

NGT

Question 10

types of lung injury that ventilation can cause

Answer 10

barotrauma - damage to airways from high pressures
volutrauma - high tidal volumes damages the balloon lining
atelectotrauma - too low PEEP means the bubbles eventually pop from the change of pop and unpop
oxygen toxicity - CLD, ROP

Question 11

what O2 level do we target in premmie neonates?

Answer 11

90-95%

Question 12

difference between IMV and SIMV

Answer 12

i. Intermittent mandatory ventilation – ventilator does what it is set for regardless of baby’s effort. increased gas trapping
ii. Synchronised intermittent mandatory ventilation – ventilator supports a set number of breaths. can lead to inadequancy

Question 13

difference between pressure-limited and volume-limited ventilation

Answer 13

pressure-limited = setting PIP = volume delivered depends on compliance the lungs. can set max PIP, but your TV can vary breath to breath

volume-limited = setting TV = pressure still varies depending on compliance.

Question 14

target pH, paO2 and paCO2 on vent - why?

Answer 14

pH 7.25-7.35
pCO2 45-65
paO2 50-70

relative permissive hypercapnoea to avoid overventilation
except in pulmonary htn, where alkalosis improves vd

Question 15

ways to increase oxygenation vs reduce CO2 (as per Tala)

Answer 15

inc O2 by:
inc PEEP most important
inc PIP
inc i time - beware of hyperinflation
…and inc FiO2

decr CO2 by:
inc TV (and by proxy, inc PIP) TV > PIP
inc RR

Question 16

idea number of ribs on CXR for good ventilation

Answer 16

8-9

Question 17

what does reducing or increasing frequency do on HFV

Answer 17

reduce frequency = increases ventilation
increase frequency = reduces ventilation

Question 18

IPPV indication

Answer 18

apnoea