Thank you all for your answers! In our unit this is a nursing decision as well. I feel like we use manipulation a lot and wonder about the implications on short and long term.
What temperature method do you use as standard of care?
We also practise some manipulation in preterm infants but only if otherwise well (preterm infants with functional GI problems) - if we suspect NEC, manipulation is a no-no.
This practise is usually not a doctor's decision, usually nursing staff decide to do this if they believe it helps.
Who is working with the interfaces for CPAP of STEFAN? Many users in Germany? NICU level 3?
Although we are working with the Flexitrunk and the VYGON at two different locations, we might be looking for a new system, hoping to find experience in this CPAP interface.
As above, in the VUMC Amsterdam we use, binasal Vygon. The pressure is measured at the end of the F@P tubing with a pressure-tube connected to the ventilator. We hardly give more than PEEP 8 (flow 8 liter) We use it for NCPAP en NIPPV. When suction is needed we remove one tube from a nostril, put a knot in it, so O2 (and some PEEEP?) is delivered; suction with catheter or with a Tendernose. With loads of secretion the tape will come lose sometimes, but overall no problems and no skin trauma. You can also insert one Vygon-tube, connected to your T-piece and let O2 and air flow, before extubating. With weeks/months of nCPAP the kids do get irritated by placing the tubes, no different than with mask/prongs.
There is offcourse a resistance, especially with the smallest size. But in clinical practice we don't see that. We have used this with the Leoni ventilator and now with the Fabian ventilator.
If you are in Amsterdam, you're welcome to come and visit