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We are starting to use NIPPV more on the ELBW babies but have trouble with alot of air in the belly, Causing feeding issues (vomiting from excess air)Trying the RAM cannula but doesn't seem much better with the air. What do you do about the excess air besides aspirating every hour. Also do you get the PIP set? We use the Draeger VN500 and if we set a PIP of 20 we may get 13 if we're lucky. 

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About trying to get the PIP set:

Usually, the problema ia about a too shot inspiratory time (you may need to use 0,4 or 0,5s, even for preemies) or air leakage (usually around the nose). We use prongs with a hydrocolloid around the nose.

Screenshot_20230415-090815.png

Start with ncpap to detect easy baby need LASA if need fo2 more than 30% with peep 6-7,, once surfactant given within frist 2-3 hours,, Snippv appled as it deceased rate NIV failure... 

My review article in this topic

https://www.sciencedirect.com/science/article/abs/pii/S1526054222000641

18 hours ago, Flavio Martins said:

About trying to get the PIP set:

Usually, the problema ia about a too shot inspiratory time (you may need to use 0,4 or 0,5s, even for preemies) or air leakage (usually around the nose). We use prongs with a hydrocolloid around the nose.

Screenshot_20230415-090815.png

We do use iT of .5 sec. The leak is not the nose  but the mouth. Even with a chin strap  sometimes. Too much air in the belly is the main problem for these little babies.  

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Hehe. Same here..

Talking about CPAP, how high PEEP do you use? We increase It until 8 cmH2O. No higher.

 

Have a good Sunday! Ending night shift now 🥲

Sweden used be "low CPAP land", practically everyone got 4 cm for everything :)  But higher levels are now the standard, starting at 6 and going up to 8 cm. Disclaimer: since 2014, I work in a level 2+ unit (with inborns from 28+0) so I am not fully updated.

Have a good sleep, I am also on shift, now taking lunch!

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