westerngreen

Thank you for checking in. The infant extubated to CPAP but has not weaned off positive pressure due to WOB and tachypnea with paradoxical movement of that chest wall segment. Discussing potential interventions with family and surgical team now...

Are you using a steroid course in infants who are 36+ weeks CGA with BPD, who are not weaning on non-invasive ventilation? The group I am considering is 36-40 weeks CGA, who remain on CPAP with some oxygen requirement (~30%) and work of breathing/tachypnea who are not progressing. If so, which steroid (Decadron, Hydrocortisone, Prednisone, etc) and do you have a regimen? Thank you!

Hi all, Has anyone cared for a patient with multiple unilateral missing ribs? I have a patient missing multiple ribs on the right side. Very low vent settings but failed extubation due to work of breathing. If you have experience with this has any surgical team tried a temporary rib cage intervention (metal insert) in attempt to avoid a tracheostomy? Or have you pursued tracheostomy to defer intervention for later in life? CXR

How do you approach weaning respiratory support in established BPD? I am caring for a former 23 week infant now 47 wk CGA. On Fisher Paykel CPAP +12, 21% FiO2, serum bicarbonate 26. No pulmonary hypertension on echo. On Pulmicort and Atrovent. Not having desaturation events. Hx NEC s/p 3 bowel resections, ROP, G4 bilateral IVH with PHH. S/p DART steroids x2. How do you wean from here? We have some team members who are reluctant to wean respiratory support because linear growth is suboptimal, but I feel that is likely due to multiple GI surgeries and periods of NPO and fluid shifts post-op. while not ideal, it doesn't seem like a reason NOT to wean the respiratory support when the baby appears comfortable, is on mostly 21%, and bicarb is acceptable. Would you wean to a certain PEEP and then try high-flow? How fast/slow and how frequently do you wean? how often are you checking labs?