Persistent respiratory alkalosis

[Guest drdnarula]

Hi there,

T/SGA with perinatal asphyxia/DIC/pneumothorax/mas/ sepsis-clinically improving-activity better, no bleeds, pneumo resolved, on SIMV(1:1 vent)-13/4/23(rate) /25%-latest abg-7.6/21/102/22.Respiratory efforts are poor/ ocassional. No sedation, phenobarbitone also stopped . Responds to physical stimuli with respiration going >60. what ventilatory changes do you suggest.

[Saidy]

What tidal volume does these settings generate?

[Dinesh N Patel]

As abg suggest ,there is hypocarbian(<35mm of hg)& hyperoxia(>60-80mm of hg) both supress resp. drive.what is I time ?

I suggest I time .35 sec,reduce Fio2 to .21, reduce rate up to 12 to 15 gradually,monitor ABG closely.this might help .what about CNS status?in sever HIE you may require ventilator support for long time.

[rehman_naveed]

Tricky question. I think the baby is washing PCO2 due to low pressure 13/4 and he is compensating low tidal volume with increase respiratory rate. I believe that low pressure you r giving due to low PCO2, we also come across these situations. Try PSV mode but if still washing PCO2, baby needs extubation and put on CPAP with trigger.

[Guest drdnarula]

Tricky question. I think the baby is washing PCO2 due to low pressure 13/4 and he is compensating low tidal volume with increase respiratory rate. I believe that low pressure you r giving due to low PCO2, we also come across these situations. Try PSV mode but if still washing PCO2, baby needs extubation and put on CPAP with trigger.

thank all for your valuable advice...the baby was on psv to begin with...i brought down the rr to 20/m and fio2 to 25 and pip to 12 as there was sufficient chest rise, repeat abg done after 8 hrs on these settings..7.61/21/102. but better resp efforts so extubated to o2 hood, remained well, presently off o2 and doing well.. thanks again.

[ammar]

extubate him to NIV nowwwwwwwwwwwwwwwwwwwwwwwww