VENTILATION

(Dry Workshop)

Risma Kerina Kaban

Kamajaya Mulyana

Neonatology Division
Child Health Department
Faculty of Medicine University of Indonesia
Cipto Mangunkusumo Hospital
 Non-Invasive Ventilation During Transfer to NICU

Baby requiring non-invasive respiratory support following birth

All Gestational Age

Single prong (ETT) CPAP

• via Neopuff® infant T-Piece Resuscitator

• via Hamilton® transport ventilator (non-humidified)

NICU

Binasal CPAP (bubble) HFNC

via Hudson prongs

2
Cipto Mangunkusumo Hospital Guideline
 ……NIV During Transfer to NICU
Baby requiring non-invasive respiratory support following birth

< 30 weeks Gestation? ≥ 30 weeks

Binasal CPAP Single prong (ETT) CPAP

(via Hudson prongs with humidified (via humidified Stefan circuit on transport cot)
Stefan circuit on transport cot)

NICU NICU
Provide binasal CPAP (bubble) Continue single prong
as per medical order CPAP in NICU cot

≥ 30 % Is ongoing respiratory support required?

Oxygen requirement? YES NO

< 30 %
Trial off respiratory support
Commence nasal high flow as per medical order
3
The Royal Women’s Hospital. Policy, Guideline and Procedure Manual. 2017
Current Common Ventilation Management

• HFNC
• CPAP
• NIPPV
• CMV
• HFOV
Nasal High Frequency Oscilatory Ventilation
(nHFOV)

• nHFOV is a non-invasive ventilation mode that applies

an oscillatory pressure waveform to the airways using
a nasal interface.

• During nHFOV, spontaneous breathing is maintained

and oscillation is given along with changes in airway
pressure.

• The transmission of actual oscillations to the alveoli

tends to be minimal compared to invasive modes
because the risk of leak is unavoidable.

De Luca, D. Arch Dis Child Fetal Neonatal Ed 10(1136). 2016

 nHFOV Operational
• The binasal short prongs interface is technically feasible and can provide
effective ventilation.

• Nasal masks are as effective as binasal short prongs in providing CPAP.

• Nasal-mask-nHFOV has been used in clinical practice and is suitable for nHFOV.

Suggested parameters boundaries for NHFOV use in two clinical scenarios

De Luca, D. Arch Dis Child Fetal Neonatal Ed 10(1136). 2016

 SCENARIO
• Baby A was born at 28 weeks’ GA and BW 1000 g with grade IV RDS.
1st surfactant has been administered. The patient got invasive
respiratory support (CMV) for 3 days.Current blood gas analysis:
- pH 7.35
- pCO2 40 mmHg
- HCO3 20
- BE – 3.
- SaO2 93-94%
• Ventilator setting: RR 30 x/minute, Vt 3.5, FiO2 21%.
• Current Chest X-Ray shows improvement.
• Succeed CPAP test. (How to do the CPAP Test)
 weaning
• CPAP or NIPPV or HFN or NHFO
• Setting ?
 Case 1
• 30 minutes after extubation, BGA test result :

pH 7.30
pCO2 48
HCO 21
BE -3

Saturation 90%

•What will you do next?

 Case 2
• 30 minutes after extubation, BGA test result :

pH 7.25
pCO2 30
HCO 18
BE -7

Saturation 97%

•What will you do next?

 Case 3
• 30 minutes after extubation, BGA test result :

pH 7.35
pCO2 45
HCO 20
BE -5

Saturation 94%

•What will you do next?

THANK YOU