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nashwa

INSURE technique

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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??

 

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Do you refer to the 2019 European Consensus guidelines on RDS?
https://www.ncbi.nlm.nih.gov/pubmed/30974433
Stefan, 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??


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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.

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@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!

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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!!!

 

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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?

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@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

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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.

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We are giving fentanyl 4mic/kg and atropine 20mic/kg in elective intubation
But I read that remifentanil is ultra short acting and used in INSURE??? any one use it??

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On 11/9/2019 at 3:13 PM, nashwa said:

But I read that remifentanil is ultra short acting and used in INSURE??? any one use it??

There are several articles describing its use for this purpose and I would agree that it has very desirable properties.  Sadly, not stocked by pharmacy at the institutions I have worked at recently.

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