(精选)Ventilation Strategies in Newborn教学课件.pptVIP

Ventilation Strategies in Newborn Modes of Non-invasive Ventilation NCO2 NCPAP SiPAP NIPPV Nasal Cannula Oxygen Indications Initial therapy for infants ≥ 34 weeks with TTNB or pneumonia who have minimal respiratory distress Resolving BPD Mild AOP despite caffeine Post-extubation for infants who are unlikely to tolerate NCPAP (37 weeks) Infants who are weaning from NCPAP, but still have O2 requirement Mechanism: provides degree of CPAP depending on flow rate NCPAP Indications: Initial therapy for infants with RDS, TTNB or pneumonia. Post extubation to maintain FRC. BPD or evolving BPD. Infants with moderate to severe AOP despite caffeine. Mechanism: Increases FRC by preventing alveolar collapse at end expiration Stents open the upper airway Guidelines: Use pressures +4-8 cmH2O. Alternate nasal prongs and nasal mask in patients requiring more than 1 week of therapy to change pressure points and avoid cutaneous and mucosal breakdown. SiPAP Indications: Initial therapy in infants with RDS, or infants who have failed NCPAP. Post-extubation for infants 28 weeks. Evolving or established BPD with FiO2 requirement ≥ 50% or significant respiratory acidosis*. Infants with moderate to severe AOP despite NCPAP. SiPAP Mechanism: Provides bi-level CPAP Increases FRC by providing periods of high expiratory resistance. CO2 removal occurs during the transition from high to low PEEP, proportional to the P difference. SiPAP Guidelines: Provides bilevel CPAP and is asynchronous. Set CPAP to 4-6+ based on lung inflation, and PIP +4 above CPAP. Set rate at 20-40 bpm Set Ti at 0.5 to 1.0 second Typical starting settings: Pressures 10/6 x 30 x Ti 1.0 Use invasive heated humidification settings NIPPV Indications: Initial therapy in VLBW infants with RDS or pneumonia. Post-extubation for infants 28 weeks. BPD or evolving BPD with FiO2 50% or significant respiratory acidosis* despite NCPAP. Infants with moderate to severe AOP despite NCPAP. Pressure Control/Pressure Support Most