שאלה
What would your recommendation be for giving bronchodilator to a baby on
HFOV? Would giving it in-line cause more barotrauma by the increase in
flow to nebulize the treatment or would handbagging the treatment cause
more harm due to loss of alveoli recruitment from disconnection? Thank
you for your input.
Mila Flores, CNS, NNP
PIH Whittier, CA
תשובה
Message: 1
Date: Thu, 25 Dec 2003 09:19:40 +0000
From: [email protected]
Subject: Re: Bronchodilator via HFOV
As with any other type of ventilator, you would reduce the flow to
compensate the flow given via the nebulizer. In the Sensormedics 3100A, we use the flow
to adjust our desired MAP, so if we give 5 LPM of flow via the neb, we would reduce the HFOV flow by 5 LPM, but only during the time of the treatment.
Many bronchodilators can be given by Metered Dose Inhalers, which would
resolve this issue. We do the same on our vents, except the Servo 300A, where we use an Ultrasonic Nebulizer(Siemens model 345)
Richard M. Hoskins RRT C-CPT CPFT
Neonatal Intensive Care
Respiratory Care Services NICU
Christus St. Joseph Hosp
Houston, Tx 77072
713-757-7564
Message: 2
Date: Thu, 25 Dec 2003 07:12:15 -0600
From: “Rob Trusty” <[email protected]>
Subject: Re: Bronchodilator via HFOV
We don’t give nebs when they are on HFOV because we don’t want to lose what lung recruitment we have gotten and the way the flow works on the HFOV they would get very little if any of the brochodilator. If you neeed more info call your Sensormedics rep.
Rob Trusty RCP,RRT-NPS
Childrens Hospital and Clinics
345 No. Smith Av
St Paul MN 55102
Phone 651-220-6350
Pager 651-527-8127
Fax 651-220-6778
Message: 3
Date: Thu, 25 Dec 2003 13:37:01 -0600
From: “David Purvin” <[email protected]>
Subject: bronchodilator via HFOV
Hello Ms Flores,
I would get a small MDI connector and connect it between the end of the circuit and the ETT tube. You don’t have any worries about extra flow from an in-line neb and you don’t have to worry about disconnecting and losing Paw. Also a few thoughts. I don’t know that neccessarily adding flow from an inline neb would cause more barotrauma. The extra flow may just be automatically compensated for much like when you add in inline neb on the Drager. I don’t know as fact though that the HFOV does this.
Secondly, if it doesn’t compensate automatically, you could always adjust your Paw with the “limit” rather than the “adjust” on the vent.
This way if the added flow was an issue for the vent, the “limit” would act just like a dump valve. But, even if you were to use in-line nebs, you still have the problem of disconnecting and losing recruitment when it was time for the treatment. The only way I could see how you would be able to give a neb (i.e. disconnect and break the circuit) without losing your recruitment, would be to physically pinch the ETT (effectively trapping your Paw in the lungs), throw your inline treatment in, then restart the oscillator up to allow the circuit to
establish the Paw in the circuit and then un pinch the ETT.
Hope This Helps,
David Purvin, BS, RRT-NPS
Presbyterian Hospital
Dallas, TX
תגובות רוצה להצטרף לדיון?
יש להתחבר כדי להגיב.
התחבראין תגובות עדיין. היה הראשון להגיב!