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Christian Heiring

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Christian Heiring last won the day on October 21 2017

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  1. Still no policy. Just trying on a few patients making up our minds about shiftning to seattle-PAP
  2. Dear collagues In our nursery we use BabyFlow from Dräger to provide NIV via VN500. We are planning to introduce the Seattle-PAP system (a bubble CPAP system) from Dräger to deliver nCPAP. Previously we have used beneveniste-CPAP. So moving to BabyFlow is quite a big step as the headgear and interface is quite different and much more bulky compared to what we have used for many years. Is there anyone out there using BabyFlow who would be willing to share experience? Our nurses are working hard to get used to the nasal interface and fixation system and especially when using bubbleCPAP we have lots of difficulties with leakage. many thanks in advance cheers Christian A few words about the unit: Level 3 NICU in Denmark. From 23 weeks GA to term+, noninvasive resp support and Conventional and HFO ventilation, iNO, ECMO, cardiac and pediatric surgery on site in addition to ENT, ortho and neurosurgical surgery and retrieval service
  3. The praxis described by Thx3 is very sensible and similar to what we use in my unit. We use HFO on VN500 either as primary mode or rescue mode. In RDS you can often start at 10Hz and VG around 1,5-2 ml/kg and then adjust VG upwards or downwards depending on pCO2 (assuming the lung is adequately recruited by using appropriate MAP) or start without VG and adjust amplitude based on chest wiggle and pCO2 trend, and when you have the right number you lock the VtHf by adding VG / but remember to allow the maximum amplitude to be set well above the avarage needed to achieve the set VtHf. The VN500 delivers a very consistent and stable Vt in VG mode - the Mve trend line becomes completely flat and you don’t see many surprising pCO2 changes once you have the right VG. Also in my view you can theoretically archive more gentle ventilation by going up on frequency with a constant VtHf and thus keeping VtHf below dead space volume rather than using lower frequency to achieve higher Vt (with out VG). However still not much litterateur to support but Jane Pillow and Manuel Lucnas groups have done clinical studies on HFO-VG
  4. Check this case-report: Moscatelli A, Pezzato S, Lista G, et al. Venovenous ECMO for Congenital Diaphragmatic Hernia: Role of Ductal Patency and Lung Recruitment. Pediatrics. 2016;138(5):e20161034 http://pediatrics.aappublications.org/content/138/5/e20161034
  5. There is not much evidence out there to support the use of rocuronium. Nevertheless rocuronium is supported by AAP, and as far as I understand their recommendation in this fairly old paper, it is preferred to succinylcholine: Premedication for Nonemergency Endotracheal Intubation in the Neonate Praveen Kumar, Susan E. Denson, Thomas J. Mancuso and Committee on Fetus and Newborn, Section on Anesthesiology and Pain Medicine Pediatrics 2010;125;608-615; originally published online Feb 22, 2010; DOI: 10.1542/peds.2009-286 We have used it for several years in our unit. It is comparable to succinylcholine in terms of onset of action, but of course the duration is longer. We still haven't had any adverse effects. I have no experience with sugammadex. Chest rigidity with fentanyl is limited if slow infusion is used as pointed out in the post above cheers
  6. Perhaps this is helpful as well: http://aomori-nicu.jp/english/track-record/babylog-vn500-advance cheers Christian
  7. Dear all @ 99NICU I work in a busy level 3 NICU providing all NICU therapies including ECMO. We also provide intensive care treatment to a selected category of pediatrics patients up to 12-24 months in a designated are of the critical care department. Providing a number of political and technical issues are sorted out we will probably be able to build a brand new building that will be going to house all the pediatric/neonatal and maternity services in our large tertiary institution. We have been requested to start discussing how we would like a new unit (NICU/special care) to be designed. The new unit should be able to combine facilities for high-end intensive care while still being able to offer state of the art family centered care. A design providing optimal patient flow, work space and family comfort is high priority covering all areas of care from the non-intensive late preterm, to birthing suites, surgical room etc. Furthermore we have been told that this innovative process should not be constrained by "money issues" as 2 large and very ambitious private funds have offered to fund the new hospital building providing that we can come up with sufficiently innovative ideas and proposals. In order to get inspiration we will have to look abroad, and therefore I would like to ask people connected to 99NICU if any of you are either working in new well designed facilities or know of some in the area you work or perhaps are in a similar process. All ideas and inputs will be most welcome - specifically if any of you have thoughts about how the ideal NICU should like, please share Many thanks in advance Christian Neonatologist Copenhagen, Denmark
  8. 1) + 2) no 3) similar to what Stefan Johansson writes above Christian Rigshospitalet Copenhagen
  9. Dear all, I would like to know if any units as of now have started to use paracetamol as a treatment for PDA in VLBW/ELBW. There seem to be a few published studies looking at paracetamol as an alternative to indomethacine/ibuprofen and a few studies recruiting at the moment. Personally I am not quite sure what to think, and just wanting to hear if there is any experience out there. cheers Christian
  10. No idea. I am asking the same question. But it has been decided that my Unit should try this kit.
  11. Hi My unit wants to trial the haumont kit as an alternative to placing longlines - http://www.vygon.com/en/products/products_act.php?segm_id=13&prd_cde_movex=00218401&PHPSESSID=8b28ab00154e9c86fd7176f7289ede05 I was hoping someone out there might have some information or experience they want to share Cheers
  12. Ups. Typo. Last sentence was meant to be "and why". I am specifically interested in your opinions about the Kindle versions Many thanks in advance
  13. Hi Has anybody read the new version of Roberton and Rennie? Would most people still prefer Avery or Fanaroff rather than Roberton Andy why? Cheers
  14. Hi Jack Thanks for sharing. The RCH link is from Royal Children's in Melbourne and not UK. "The website neonatology on the web" has a good link collection: http://www.neonatology.org/neo.clinical.html Christian
  15. Dear all, I would like to contribute more to 99nicu and often come across very interesting cases that could generate good discussion in the virtual NICU. However I find it difficult to post. Everyone can see where I work, and if the case is a bit unusual, in theory the patient can be identified. Is it possible to post cases anonymously via the administrator, in that case I would post many more. Also when people post cases I think it is important with few words to describe the facility the patient is admitted to, what level NICU is it and importantly is it a resource rich or limited setting. Advices regarding lost of surfactant, iNO, bosantan, ECMO etc does not make much sense if the patient is in a poor public hospital without access to these treatments Cheers Christian
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