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Andrej Vitushka

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Everything posted by Andrej Vitushka

  1. 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?
  2. 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)?
  3. 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.
  4. 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!
  5. 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! :).
  6. 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!
  7. 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.
  8. Dear colleagues! Many thanks for nice and fruitful conversation!
  9. Bimalc, thank you for your suggestions! Regarding dry/birthweight. Until what day will you use it in VLBW infants? 10th? 14th?
  10. 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.
  11. Thank you Nashwa and Naveed! What about the weight for calculation for infant with sepsis? Which one do you prefer? Or maybe another variant?
  12. Dear colleagues! Please share your experience regarding 2 issues about infusion in preterm infants. Unfortunately there are no solid guidelines but questions of fluid supplementation and parenteral nutrition are obviously important for premature patients. There are considerable differences in proposed volumes of fluid requirement per day in literature. For example, Avery’s Diseases of the Newborn (10th edition from 2018, freshest one) provides following numbers: From the other hand, European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2016 Update states that “Typically fluids are initiated at about 70–80 ml/kg/ day and adjustments individualized according to fluid balance, weight change and serum electrolyte levels”. From the third point of view, National Guidelines for Parenteral Nutrition of Neonates in Russian Federation has following recommendation for daily fluid requirements: Bodyweight, grams Daily Fluid Requirements (mL/kg/day) 0-24 hours 24-48 hours 48-72 hours >72 hours <750 90-110 110-150 120-150 140-200 750-999 90-100 110-120 120-140 130-180 1000-1499 80-100 100-120 120-130 120-160 1500-2500 70-80 80-110 100-130 120-160 >2500 60-70 70-80 90-100 110-160 Which numbers are closest to yours? 2. 2. Second question. Clinical case J Premature infant with sepsis on Dopamine with edema because of boluses and severe condition. Now there is a beginning of the 3rd day of life. When calculating infusion for him what bodyweight we consider: 1. actual one (plus 15% of birthweight) 2. minus 3-4,5% from birthweight (ideally we need at least 1,5% of weight loss per day) 3. birthweight 4. something else? Thanks a lot!
  13. We do not have iNO either yet. But when I was on observership in NICU of Medical University Hospital in Graz (quite close to you ) in 2015, they did iNO to the infant on CPAP. It was a complicated heart defect with persistent pulmonary hypertension. INO was titrated according to SpO2 and daily heart ultrasound. As far as I remember they in increased sildenafil per os aiming to withdraw iNO eventually. Not so much but hope it helps.
  14. Dear colleagues! Many of you know how could be diffucult for neonatologist from developing country to get an opportunity to see on own eyes work of busy NICU in developed country. Especially to spend several weeks in large university clinic. There are many reasons for this, mainly financial, but also a lack of appropriate contacts. I want to apply to the Fulbright Visiting Scholar Program -- non-degree, post-doctoral award program for researchers and experts from Belarus who wish to conduct post-doctoral research, lecture, or pursue combined lecturing and research in the United States (you can read about it here https://by.usembassy.gov/application-period-started-for-the-fulbright-visiting-scholar-program-2019-2020/?fbclid=IwAR2qktBr88cqeZqKvWXTwsz1B1Qe4bSSexNyvSXvwvs8ZDbyGS4kl1ce_nc). The program is nice and allows to spend 3-6 months in U.S. institution, covering many financial issues. As program states: The Fulbright experience should be of value not only to the scholar, but also to the scholar’s home university, as well as to the host U.S. institution". So I need contacts in NICU of tertiary (preferrably university) U.S. clinic which could be a spot for this study-visit. There are 3 interests in this scholarship -- 1. to delve deeply into daily routine of busy U.S. NICU (modern approaches to management of different cases (extreme prematurity, cooling for HIE, iNO use, hemodynamic instability etc), 2. to get tips how to make and maintain up-to-date local treatment' protocols 3. to understand how modern neonatal research looks like and how it is connected with practice. For the application I need letter of invitation from a preferred U.S. host institution. Maybe someone from 99nicu community work in such clinic and ready to share clinical and research experience with me? Any suggestions of clinics with strong NICU and research? How to get an invitation letter? Ofcourse I can use some rankings in Internet like this: https://health.usnews.com/best-hospitals/pediatric-rankings/neonatal-care, but recommendation form colleagues is far better source. Many thanks!
  15. It is very useful information, Stefan. Thank you. I would ask our lab people about validation.
  16. But what do you think about Hb provided in Acid-base analysis by Radiometer ABL? Anyone use it as guidelines for transfusion? Rarely we do this especially in VLBW infants with obvious bleeding. Thanks
  17. Dear colleagues, many thanks for useful suggestions and remarks.
  18. Hamed, thank you! Is there any difference between venous and arterial Hb/Ht?
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