pmaglidt

We use infasurf here 3ml/kg and instill half of the dose over 1-2 mins with one side of the baby up so the surfactant migrates to that side and then bag for 60 secs at slightly higher pressures then rotate the baby to the other side up and instil the other half.. If the baby is flat its hard to tell if the deposition of the surfactant if equal on both sides of the lungs.

what about the pulm hemorrhage being caused by the use of surfactant??

From the initial post about the temperature with nasal IPPV we use it with the invasive mode on the passover humidifier in pre-term infants 37 C but switch to non-invasive for the more term babies at 32 C

We use the infant flow for NIV CPAP with either the prongs or mask. When it comes to needing a rate and more support the carefusion NIV positive pressure device works great (having cpap and bipap capabilities) to attempt keeping a baby having respiratory distress from getting intubated. At a hospital I worked at we also utilized what they called nasal-pap (NIV) throught the PB840. I feel the SIPAP machine from carefusion is great due to flexibility of starting a baby on BIPAP, if needed and the changing them to CPAP and only using one machine. I have noticed the selective use of surfactant being more moderate over starting a baby on 5cmH2O CPAP and then weanng them off ASAP after there has been the recruitment needed. The surfactant deficiency in premies is an issue though i have seen surfactant replacement therapy being used less and more selectively....

The use of the SIPAP non-invasive machine in bi-phasic mode(BIPAP) is a great arrow in the quiver to try before intubating a baby that is in respiratory distress and having apneic spells. As a respiratory therapist I like this technology because it allows at least the baby a chance to get through those periodoc breathing episodes and help maintain stimulation and allow the baby to have a decent minute ventilation. It also can prevent the baby from buying a tube right away. It has a set rate, pip, peep, I-time and with a upper and lower pressure that has a delta-p effect..