Andrej Vitushka

Thank you. Wise approach.

Thilo, thanks for sharing your experience. Totally agree that two way CO2 measurements (Tc and eT) would be the best option. How accurate and stable your sidestream sensors' measurements vs PaCO2?

@Vicky Payne many thanks for useful insights!

Many thanks @Vicky Payne and @ali Great to know this. Vicky how do you monitor CO2 mostly - by transcutaneous device as Alistair et al. do or by taking blood gases? @ali how are you satisfied with trascutaneous monitoring in unstable VLBW infants in terms of accuracy and complications (burns first of all)?

Wow! Amazing thing! Thank you, Stefan!

Dear colleagues There is an idea to investigate deeply correlation between EtCO2 and NIRS data and probably to develop some device for extracting, coupling and analysing these data. That's why I am kindly asking you, dear colleagues: 1. Please share your experience about how often do you use capnography in intubated and non-intubated infant at NICU. Is it like a standard for intubated infants? 2. What EtCO2 measurement device provides you with more accurate measurements vs PaCO2? 3. Do you use capnography and NIRS simultaneously in most severely ill infants? Do you also consider EtCO2 data in this case when you are estimating brain perfusion? Many thanks! Andrej Vitushka, MD, PhD, Minsk, Belarus.

Thanks Lionel and Ismail! And what about trachea? When it should be cleared?

Dear colleagues Just a naïve question. Endotracheal, nasopharyngeal and oral suctioning in infants -- what first, second and third? My idea was 1. Trachea 2. Oropharyngeal 3. Nose. But some colleagues told that oropharyngeal suctioning first because we need to clean upper airways in order to avoid risk of microaspiration by ETT during the endotracheal suctioning. For example guidelines from Ireland https://www.olchc.ie/Healthcare-Professionals/Nursing-Practice-Guidelines/Suctioning-Guideline-Sept-2017.pdf support my opinion. But the other opinion sounds reasonable too. Where the truth? Many thanks!

Great job, Stefan! Many thanks! What a clear picture!

Nice suggestion! Especially if you have a appropriate ultrasound machine and relevant knowledge to use it by yourself or possibility to invite specialist to do it. Definitely bedside echo must be a standard. Must be, but not now yet universally (unfortunately). So sometimes also clinical criteria help as central cyanosis, refractory arterial hypoxemia and pre/postductal SpO2 difference more than 20%. Also "quite healthy" looking non-edematous lungs together with persisting hypoxemia, low SpO2 (heart defects should be prenatally excluded). But all these are not reliable. So May the Echo be with You! :).

Dear colleagues! Hope you all are doing well in 2020 :). Maybe anyone has an experience of using nebulisers in SLE 6000 and Leoni Plus ventilators? Some of our old machines need to be replaced and we have to make our choice about new ones. In good old and simple Newport E100 (reliable as Kalashnikov rifle by the way) there is a special port for nebuliser, making additional flow in circuit when activated. You only need a tube with medication's camera attaching to the Y-piece of the circuit and to switch on the particular button. How is it working for SLE 6000 and new Leoni Plus ventilators? The same way, or not? As far as I understood SLE has separate nebulisation port but I failed to find any button for nebulisation in manual. About Leoni I know even less :(. Do you always need to buy additional stuff like Aeroneb for SLE6000 or LM M-neb for Leoni? Unfortunately I cannot understand this by myself from Internet resources. Many thanks!

We use LISA for 2 years and have about 40 patients less than 1000 g of birthweight already. Data are still collecting but preliminary results are reassuring -- only 2 deaths in LISA group (including one because on NEC on third week of life), only 1 IVH III and much less days on ventilator. Out method is close to one used by Dr. Cardona and colleagues (they were very kind and shared the method with us). Non invasive ventilation (Pin 20-22 mbar, PEEP 5 mbar and Flow 10 l/min, about 20-30 breaths per minute) via mononasal cannula by NeoPuff-like device is used. Frequently we do not even use Magill foceps (it is quite easy to intubate trachea by thin catheter). Caffeine Citrate as premedication. Constant suction from stomach is needed. Except episodes of apnea (usually on day 3) sometimes we meet feeding intolerance during the 1-2 day of life (maybe because of intestinal overdistend by non-invasive ventilation). Now the method looks promising.

Dear colleagues! Many thanks for nice and fruitful conversation!

Bimalc, thank you for your suggestions! Regarding dry/birthweight. Until what day will you use it in VLBW infants? 10th? 14th?

Nathan, many thanks for your suggestions. It is really true that additional fluids for catheters and drugs (incl. Dopamine and vasopressors) have considerable contribution to the daily volume. Interestingly we also do not have consensus even in our NICU about daily fluid requirements. Frankly speaking we are not very restrictive -- we start from 80-90 ml for premature infants with D10, quite liberal in boluses and excessively sticking to the numbers of median arterial pressure on monitor (we love to see MAP 30 mmHg at least and do not like less even if there are no acidosis and other signs of hypoperfusion). We have plenty of BPD and quite many PDA. Sticking to the birthweight until edema is resolved -- it is very good idea.