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TRANSCRIPT
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DeliveryRoomBubbleCPAPOptimizingRespiratorySupportinthe
VeryLowBirthweightInfant
DorothyHutchinson,MSN,CNSMichelleThomas,SNIV,ALSRNPaulaDaugherty,MPH,RRT-NPS
ObjectivesAttheendofthisinteractivelecturesession,participantswillbeableto:• DiscussrecommendationsforoptimizingrespiratorysupportforVLBWinfantsinthedeliveryroom• Discussteammembercompositionanddynamicsinthedeliveryroom• Describeusefultechniquesandprocedurestoconsiderwhenimplementingpracticechangesinthedeliveryroom
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“Stabilizationinthedeliveryroomwithpromptrespiratoryandthermalmanagementiscrucialtotheimmediateandlong-termoutcomeofprematureinfants,particularly
extremelyprematureinfants.”
Whatdoesthislooklike??InJanuary2014theAAPreleasedapolicystatementonrespiratorysupportfornewbornpreterminfants.Therecommendationsinclude:• Usinganindividualizedapproachtotheprovisionofcare• EarlyuseofCPAPwithselectiveuseofsurfactant• Ifmechanicalventilationisnecessary–earlyadministrationofsurfactantwithrapidextubation ifpossible
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Rationale
• InfantswithRDSmayvarymarkedlywithregardstotheseverityofillness,maturity,andthepresenceofothercomplications• CPAPstartedsoonafterbirthisastrategythatappearstoreduceBPD/deathandisanalternativetotheprophylacticorearlysurfactantapproach(withmechanicalventilation)•WhiledeliveryroomCPAPisnotexpectedtopreventallintubationevents,thereisnotevidenceofharmassociatedwithstartingCPAPinthedeliveryroom
WhatdoSTABLE&NRPsay
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STABLEAirway
• CandidatesforCPAPnotspecifictodeliveryroombutinclude• AdequateRespiratoryrate• Increasedrespiratorysupportneeded• IncreasedWorkofBreathing• IncreasedO2requirements• SomeApnea,mildacidosis• Co2<55-60• Supplementaloxygen40-70%tomaintainO2Sats 90-95%• AtelectasisonX-ray
STABLEAirway• InfantswhoarenotcandidatesforCPAP• Rapidprogressiverespiratoryfailure• Increasedfrequencyandseverityofapneawithcyanosisandorbradycardia• Gasping• Diaphragmatichernia• TracheoesophagealfistulaorEsophagealatresia• Choanal atresia• Cleftpalate• Poorrespiratoryorcardiovascularfunction
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NRPDeliveryRoomrecommendationsforCPAP
BreathingHeartrate>/=100LaboredbreathingOxygensaturations<targetsaturationrangeUseT-PieceresuscitatorIfprolongedCPAPconsidernasalprongsornasalmaskandafterinitialstabilization,CPAPcanbeadministeredwitha….Bubblewatersystem,adedicatedCPAPdeviceoramechanicalventilator
HowtoimplementBubbleCPAPintheDeliveryroom
IdentifyteamPre-BriefEquipment&Suppliessetupandchecked
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DeliveryPersonnel/TeamComposition
• Shouldbebasedonindividualpatientneeds• Atleasttwoproviderscommittedsolelytotheevaluationandcareofthenewborn• MostTeamshavealead(MD,NNP,oradvancedpracticeRN)aswellasanadditionalRNorRCP
BubbleCPAPforVLBWInfantsintheDeliveryRoom
•WorkwithteamtoidentifypatientsthatwilllikelyneedCPAPsupport(i.e.
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FlowtoinspiratorylineforBubbleCPAP
O2Tubingconnection(8-10L/min)
VLBWRTDeliveryItems:• BC190-05(FlexiTrunkInterface50mm)
• BC800-10(smallmask)• BC801-10(mediummask)• BC3020-10(3.0mmnareprongs)
• BC3520-10(3.5mmnareprongs)
• 22-25cmBonnet• 25-29cmBonnet• Oxygenconnectortubing• 500mLbottleofwater
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KeeptotakebacktoNICUfor
bedsideset-up
ConnectO2
tubingfor
shuttletransporttoNICU
MD Resource
RNRT The Baby
Let’sPractice
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DeliveryRoomBestPracticeDiscussion
WhoisdoingBubbleCPAPindeliveryroom?Howdoyoucoordinatecare?
WhoisgivingSurfactantindeliveryroom?Howareinfantstransportedfromthedeliveryroom?
Additionalbestpracticesharing?