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Devices for ventilation in resuscitation


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Dear collegaues!

I´m very curious if things have changed and wanted to ask you all around the globe three questions on ventilation in the DR and also in the NICU?

1. What device do you mostly (only) use?

a) Self inflating bag

b) Flow inflating bag

c) T-piece like Neopuff or other

d) Ventilator

2. Do you also use some kind of respiratory function monitor and in that case, what parameter(s) do you primaly take in consideration for adjusting your actions (PIP, PEEP, Ti, Vte, Rate, leak%, other)?

Yes/No

3. What adjunct to your ventilatory device do you prefer to start with?

a) mask

b) nasal prongs 

c) LMA

d) ETT

Any other comments?

Thank you!🙏

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1c

2 No

3 depends on the context (pre-birth history, antepartal course, gest age etc-etc) but non-invasive startpreferable. In preterms, we apply nasal prongs and CPAP directly after birth (and soon, there may well be a nasal prongs/device for nasal ventilation, and connected to the NeoPuff/similar :) )

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1/   in DR C, in NICU A or  Ventilator

In NICU Depending on situation and fastest availability. (when baby was on ventilator the ventilator is fastest with mask and I can see all items as suggested in question 2)

2/ In DR not, In NICU when mask is connected to ventilator

3/ A or C, depending on situation. (And I'm a nurse who is not qualified to intubate)

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1. DR c, NICU c or d.

We don't have heater integrated in our T-Piece setting so on the ward NICU we prefer warm and humidified gas (ventilator)  if possible.

2. Not now in DR - we asked for budget to implement RFM next year but it's formal only for research ;-). Main issue is that there is no one with full approval/certification for clinical use in our population. Is well CE (technical) but a grey zone for our purpose (high risk intervention while stabilisation/resuscitation).

If we use ventilator we can use measurements from this devices (Fabian).

3. We regularly start with a (facemask) and place the baby as soon as possible on binasal nCPAP with mask  (Bi-nasal with flowdriver).

In some cases we start with bij-nasal mask and in case of expected difficult airway we use  c (LAM) or d (ETT).

 

I would be very intersted in more information about a "legal" RFM for use in our population. Did anyone find a device?

And also if someone is using EIT combined with RFM in the stabilisation of premature babies :-)

 

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17 hours ago, Emilio Escobar said:

i see a new devide called NEO TEE, is this sure for terms and preterms babies?. What do you say about Laerdal air bag (with PEEP)?

We use the Neo TEE here in Vienna as an alternative for bag-mask-ventilation on our unit. It works, but is a bit more frail and I am not sure about reliability. In studies it does ok.

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I´ve never used the Neo tee, but other T-piece resuscitators which work fine, especially in preterm babies but I was a bit concerned reading this article showing that some devices do not deliver set PIP at all times https://fn.bmj.com/content/104/2/F122.abstract   

A so called PEEP valve on a bag in my opinion does not create a sufficient (or any...) PEEP. You need some kind of device with a flow. Maybe in a term baby using a 500 ml bag and slowly squeezing the bag keeping FRC, but still you don´t know the amount of PEEP.

A good adjunct in this situation could be to to use a Respiratory Function Monitor as whatever device you use you don´t know the leakage or more important the tidal volume. Even if the PIP is set the compliance changes and suddenly you might ventilate with to large VTe harming the baby.

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