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Akash Sharma

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Akash Sharma last won the day on April 7 2020

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    AIIMS New Delhi
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    New Delhi

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  1. @satyen75 sir Found that there are certain DAR filters ( Electrostatic ones and not just mechanical which can be attached to the expiratory limb) resistance increment is given as 0.7 cmH20 PFA the PDF file for it and the snapshot of the same Thank you covidien dar filters.pdf
  2. Dear sir Normally one starts off with I:E ratio of 1:2 or in some ventilators represented as a percentage like 33%.what it means is if you have selected a frequency of 10Hz( resp rate of 600) then total Ti for a single breath would be 0.03 seconds. Remember that this IE is for each oscillation and not for recruiting breaths (that has a separate entry parameter) This conventional 1:2 comes from the expiratory time constant which is twice as long as inspiratory. For a given MAP if i am able to manage oxygenation i would not touch on the IE ratio.if you feel that you are not able to maintain oxygenation for a give MAP, in order to recruit more alveolar units one may consider increasing IE to 1:1. But this might result in issues with ventilation also. It is always better to recruit with titrating MAP rather than I:E Regards
  3. @Dr Ashish Jain sir Good evening sir Sir the thinking that occurs during the time of intubtaion aerosols would be generated extends to ventilation too. A ventilated infants expired air would be vented out into the NICU atmosphere without being filtered. Quoting some lines from an article after the SARS Epidemic in Clinics in chest medicine( Attaching the article as well sir) "Measures to minimize respiratory droplet transmission include using in-line suctioning to maintain the ventilator circuit as a closed system. Humidification should be done via heat-moisture exchangers with viral-bacterial filter properties rather than heated humidifiers. Each ventilator should have two filters: one between the inspiratory port and ventilator circuit and the other between the expiratory port and ventilator circuit, to provide additional protection from exhaust gases and minimize ventilator contamination." Kindly provide your valuable opinion on the same Thank you MV SARS.pdf
  4. @satyen75 hello sir Yes sir. Putting in exhausts is a backup plan.. To truly make negative pressure isolation rooms is difficult in this situation. Exhausts is a very viable alternative sir. Thank you.
  5. Dear all As all of us are preparing ourselves to form potential strategies to mitigate and manage SARS CoV2 positive neonates, we come across various challenges. Our NICU has Sophie ventilators which do not have a expiratory filter. So the potentially infectious aerosols would be released in the NICU environment. We have not been able to devise a way to circumvent that yet. Though thankfully there have been no suspect cases so far in Delhi. But in order to prepare for a possible surge it is essential to look at such issues. Please suggest what is being followed in other units who are currently managing such neonates and suggest the possible solution to the issue that our unit is facing Thank you
  6. @kstempn and @livesynapseWhatever the amount of intake may be (even as low as 10-20 ml per kg) the intake has to be accounted for in the total daily intake. ( for fluids as well as for calories) If you are using a milk analyzer the amount of calories and proteins being administered can be adjudged accordingly. Otherwise a standard calorie intake of 65 cal/100 ml for breast milk can be taken. We have our own unit data showing lesser calories so we take that. Hope this helps.
  7. Though there is a protocol in place to premedicate with fentanyl for elective intubation and INSURE in the unit, not really sure how to go about it if the baby does not have a iv line in place and requires surfactant but not iv fluids. Most of our babies would be started on full feeds if there are no contraindications(aggressive enteral nutrition). Should a iv cannula be inserted for administering analgesia before INSURE!? and then removed.
  8. Thanks for sharing your views @Stefan Johanssonsir. What growth charts does your unit follow for extreme preterm and very preterms as norms. I would like to cite the article by Villar etal for the purpose of discussion about what postnatal growth standards to follow for preteen babies. "Villar J, Giuliani F, Barros F, et al. Monitoring the Postnatal Growth of Preterm Infants: A Paradigm Change. Pediatrics. 2018;141(2):e20172467. doi:10.1542/peds.2017-2467". Even after the Intergrowth 21 data the growth of less than 32 weeks babies still remain unanswered. By selection of an appropriate comparator only one can conclude whether increment in calorie and protein intake should be done or not. Currently we use Fenton's charts for the same. (which I feel isn't the right way to about it)
  9. It is not uncommon to have extreme preterm babies being under weight and stunted at 36 or 40 weeks PMA. Our standard of care for postnatal nutrition has traditionally been to provide nutrients which matches fetal accretion rate. But is it really wise to give the same quantity of nutrients. Preterm birth and exposure to postnatal life in itself would cause epigenetic changes in how a neonate shoudl. Metabolize and assimilate the nutrients administered. So what really constitutes as EUGR. Is it only the 10 th centile at 36 weeks and 40 weeks PMA or is it standard deviation scores below expected (like 1SD below the 10 th centile - considering that some amount of postnatal growth restriction is acceptable and expected due to the loss in the first 2 weeks ) For us its a complex issue of allowing the neonates to grow at their own centile (even below the 3 rd centile) as providing excess nutrition for catchup might result in more fat mass instead of fat free mass. (ultimate goal being adequate and appropriate body composition, linear and mass growth) On a bigger picture the question that needs to be answered is - Should EUGR be determined by a statistical definition alone based on anthropometric parameters OR should it be based on the adverse body composition analysis and neurodevelopmental outcomes at a prespecified time (which is obviously more difficult)
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