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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?
