jwiggins

We use the pixi nasal mask or the sullivan bubble nasal mask for that age group.

We have been using the crossvent 2 on transport for years. Does invasive and non invasive. I am not familiar with the fabian unfortunately.

We use neobars in preference to taping for the same reasons as the previous writer. We find that tapes need retaping too often on a sensitive skin and duoderm is so much nicer when taken off. Ett when secured on the side of the mouth with tapes have a tendency to roll in the mouth if the baby looks to the opposite of where the circuit is secured and if taped in the center of the mouth, the tapes and ETT can erode the lips and palate. Skin care is easier and you don't have that problem where drool ruins your taping job because the neobars is secured to the face far from the mouth.

I would suggest to have the circuits entering the center of the isolette instead of the sides so if baby moves his or her head, there is less tension on the circuit and hence less on the ETT. I think there should be a constructive huddle between physicians, charge RN, RT and bedside RN to determine what are the factors contributing to self extubation. Tracking this over time might show a pattern. Sedation, quality of taping and retaping are big factors for us.

We have a fleet of VN 500, babylogs and servo I. The VN's are our first choice for our babies because of the ease of hfo and the proximal flow sensor.

We haven't had cycling problems at our center. Did it pass the preuse check and the circuit check? Have you tried changing the sensitivity, clearing bronchial secretions, clearing water from hoses or optimizing ETT leak (if present)? We only use disposable F&P circuits with MR series heater. We most often use the a/c p/c mode with VG. With HFO, our VG is set between 1.6 and 2.2 cc/kg although I haven't seen evidence to prove or disprove this practice. Just remember that the function of the frequency is different in hfo+VG compared to hfo without VG. Also, when on hfo or hfo VG we use a low compliance heated chamber instead of self feed chamber. Less fluctuations of MAP with this.

We have mastisol in our unit but are discouraged to use it especially in the preterm. We use the neobars and/or duoderm to protect and adhere to the skin.

We sometimes use low dose morphine infusion on our bigger babies. We use other means first like pacifiers, sucrose, kangaroo'ing but in the end, sedation is a possibility.If we have an increase of PCO2 within the next 24 to 48 hrs post sedation use, most likely we stop the sedation.

We use etco2 on all vented NN except while hfo'ing. We use the microstream which, when leaks are less than 30%, work fine and very accurate. Emphasis on appropriate ETT sizing to minimize leakage.

We also had issues with the avea so we retired it. We bought a fleet of VN 500 and they work very well. Lovely transition from conventional to hfo and back all on the same ventilator.