A neonate delivered at 32 weeks, is put on a ventilator, X–ray shows ‘white out lung’ and ABG reveals PO2 of 75. Ventilator settings are an, FiO2 of 70, and rate of 50/minute. Next step to be taken should be ?
Correct Answer: Continue ventilation with the same settings
Description: Lets see the individual findings.
The neonate is premature.
X - Ray shows 'White - Out' : is a sign of Hyaline Membrane disease in the Newborn i.e. RDS.
ABG reveals p0, of 75 : which is acceptable.
FiO, : Fractional Inspiratory 0„ here in the ventilator settings, is 75% well above the normal.
Respiratory Rate settings in the ventilator is 50/min : Normal for that age.
Now, we have the complete picture here :
The premature baby is having HMD, and so has been put on Artificial respiration.
The FiO2 being given is in the higher normal range, and also the partial pressure of 0, in the neonates blood is acceptable . So we will avoid increasing the Fi0„ as this carries a risk of blindness by ROP (Retinopathy of Prematurity). As a rule, we avoid tampering with the ventilator rate settings, because it causes changes in the CO, levels of the blood, and consequent disturbances in the acid - base balance. This is also one of the reasons for keeping this rate of 50/min. in this neonate.
Weaning from ventilator will start once the baby shows hyper - oxygenation with the currect settings, i.e. the p0, in the range of 120 .
The answer here would be to continue the current settings till such time when the baby shows hyper-oxygenation, and then slowly wean him off the ventilator
Category:
Pediatrics
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