nashwa Posted November 1, 2019 Share Posted November 1, 2019 Any one follow a recent recommendation of European guidelines for RDS management and practice INSURE technique in ELBW, How much it working??What is average time taken to extubate babies??, how many doses of surfactant needed?? Sent from my MHA-L29 using Tapatalk Link to comment Share on other sites More sharing options...
nashwa Posted November 3, 2019 Author Share Posted November 3, 2019 Any suggestions?? Sent from my MHA-L29 using Tapatalk Link to comment Share on other sites More sharing options...
Stefan Johansson Posted November 3, 2019 Share Posted November 3, 2019 Do you refer to the 2019 European Consensus guidelines on RDS? https://www.ncbi.nlm.nih.gov/pubmed/30974433 Link to comment Share on other sites More sharing options...
nashwa Posted November 3, 2019 Author Share Posted November 3, 2019 Do you refer to the 2019 European Consensus guidelines on RDS?https://www.ncbi.nlm.nih.gov/pubmed/30974433Stefan, yes I mean the recent European guidelines of RDS. It was written that they give surfactant once Fio2 is 30 %or more for all babies. It is different than previous guidelines. Also in recent one, it suggests CPAP for all babies in delivery room for stabilization including Ex preterm. For INSURE technique, I want to ask about who practices extubation immediately after given surfactant?? What is criteria for keeping babies for some time on MV?? Sent from my MHA-L29 using Tapatalk Link to comment Share on other sites More sharing options...
erwazny Posted November 4, 2019 Share Posted November 4, 2019 Hello. We use Insure on ELBW children. And we extubate them just after putting surfactant into lungs. We wait a little bit untis surf. is absorbed (by stetoscope). But it takes just little of time. If baby is breathing, extubate and put nCPAP. It all takes maybe 5 min. 1 Link to comment Share on other sites More sharing options...
Stefan Johansson Posted November 4, 2019 Share Posted November 4, 2019 @nashwa Would be great to hear the experience by for example @Francesco Cardona , I work in a NICU with ≥28w infants now. As I understand from level3 colleagues, nCPAP with relatively high pressures is the primary mode of respiratory support, and LISA the method to give surfactant, while nCPAP is ongoing. This is said to be a successful strategy for a surprisingly large proportion of the very immature infants (also ~24-25wk), but I don't have numbers or first-hand experience myself. I have even heard discussions that staff worry about intubation skills, and how those skills are trained/kept when only a minority of ELBW infants needs intubation and invasive ventilation. A new world! 1 Link to comment Share on other sites More sharing options...
nashwa Posted November 4, 2019 Author Share Posted November 4, 2019 Hello. We use Insure on ELBW children. And we extubate them just after putting surfactant into lungs. We wait a little bit untis surf. is absorbed (by stetoscope). But it takes just little of time. If baby is breathing, extubate and put nCPAP. It all takes maybe 5 min.Erwazny, you are doing INSURE with extubation immediately even in ELBW babies, is it working in babies less than 1000 g. No need for MV for theses babies!!! Sent from my MHA-L29 using Tapatalk Link to comment Share on other sites More sharing options...
cB23 Posted November 8, 2019 Share Posted November 8, 2019 What premedication are you using for INSURE or even for routine intubation in ELBW / VLBW? Is there a gestational age below which you would NOT use morphine? Have seen some babies < 28 wks GA receive morphine and have prolonged hypotension, anuria / oliguria, rise in Cr. Seems like these babies should receive fentanyl instead? Link to comment Share on other sites More sharing options...
Stefan Johansson Posted November 9, 2019 Share Posted November 9, 2019 @cB23 we dont use Morfin since quite some years but fentanyl as analgetic during intub. even for LISA we give a small dose to reduce assumed pain of the laryngoskopy 1 Link to comment Share on other sites More sharing options...
bimalc Posted November 9, 2019 Share Posted November 9, 2019 On 11/8/2019 at 1:39 PM, cB23 said: Is there a gestational age below which you would NOT use morphine? I haven't used morphine for intubation in almost 10 years. The onset and duration of fentanyl are overall more desirable for purposes of intubation. Link to comment Share on other sites More sharing options...
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