Miguel Pantoja

I think that if you go too low in the MAP air trapping could go worse as intrinsic PEEP is higher than your MAP. In my patient we had to use Milrinone to support heart function and norepinephrine in 2 suspected VAP with haemodynamic deterioration. Here I send a chest xray of my patient. Good luck! And remember steroids, I think they helped a lot.

Dr Keszler @Martin.Keszler - If a neonate is trying to compensate acidosis and we increase VG to aviod endotracheal CPAP you think we should worry about pH, but low pCO2 is associated with PVL. So what can we do to balance both issues? - What is the lowest PIP you feel comfortable with while using VG? Patient with PEEP 5, would you feel OK if he is using PIP of 9-10? Or in that case you would consider he is approaching ET CPAP and you would increase VG?

We had a very similar 24w last year, he was in HFO for several weeks and there are some reports of using either HFJV (which we don’t have in Chile) or HFO with low rates. We used HFO+VG with a target of SpO2 of >80% (or at least to achieve a normal brain rSO2) and pCO2 65-70, using rates of 5-6 Hz to increase expiratory time. He needed dexamethasone and then hydrocortisone for weaning, diuretics for several weeks, and was discharged at 41-42 weeks of CGA with O2 0,1 lpm. Really bad chest xray though, some big bullae.