RT134 Oxygen Modalities

Question 1

Indications and Set up for N/C

Accepted Answer

¼-2 Lpm (infant) (Remember not to Occlude the Nares – about ½ only)Use to treat patients recovering from Chronic lung disease

Question 2

What are the indications for HFNC.What are the liter flows for HFNCWhat is HFNC able to do?

Accepted Answer

o Indications: Alternative form of O2 support for apenic neonateso 1-20 LPMo For oxygenation: Possible Peep like effect maybe 2 cmH20o Ability to Washout Anatomic Deadspace

Question 3

What are the indications for CPAP (Bubble or Nasal)4 indications

Accepted Answer

• Bubble CPAP or Nasal CPAPo Indications: Apnea of Prematurity Premie with Minimal RDS after delivery After intubation with surfactant administration RDS after extubation

Question 4

What are the indications for intubation for neonates and peds?6 indications

Accepted Answer

o On CPAP with Pa02 <50 with Fi02 >60o Frequent apnea despite being on CPAP and medcationso Prolonged apnea eventso Deteriorating gas exchangeo Administration of surfactanto General Anesthesia

Question 5

Indications for Airway clearance Therapies

Accepted Answer

Inability to clear own secretionso Acute Lobar Atalectasis Secondary to Mucous Pluggingo CF (No one modality is superior to the other, Choose what works best with the patient except when GERD is an issue)o NMD Hyperinflation Therapy Cough Assist IPVo Lung Abscess

Question 6

What are contraindications to airway clearance therapies?

Accepted Answer

HemopysisUntreated Tension PneumoEmpyema and large plural effusionsForeign Body AspirationHemodynamiclly UnstableFresh TrachNeonates with weak ribs

Question 7

Complications and Hazards to Airway clearance therapy

Accepted Answer

• Hypoxemiao Position Changeso Percussion leading changes in mucous positions altering gas exchangeo Atelectasis pushing out of FRC or causing large pressure changes in the lungso Bronchospasmo Increased O2 consumptiono GERDAirway Obstruction from foreign body entering the lungsIntracranial Complications/ IVH in newbornsRib Fracturing and BruisingAirway Trauma

Question 8

Selection Criteria for ECMO UCSF

Accepted Answer

• UCSF selection criteria for ECMOo Gestational age >34 weekso Weight >1.8 kgo Reversible diseaseo Vent <14 dayso Failure of Maximal medical managemento Predicted mortality of >80% by historical criteria

Question 9

Exclusion criteria for ECMO UCSF

Accepted Answer

•	Exclusion criteriao	Major intracranial Hemorageo	Lethal malformationo	Uncontrollable Coagulapathyo	Syndrome with poor prognosiso	Severe neurological injury

Question 10

Clinical Indications for ECMO UCSF

Accepted Answer

• Clinical indications for ECMOo Oxygen index 40 or greater in 2 or more ABG’so Intractable metabolic acidosiso Intractable shock-Progressive, intractable pulmonary or cardiac failure-Inability to come off cardiopulmonary bypass at operation

Term	Definition
Indications and Set up for N/C	¼-2 Lpm (infant) (Remember not to Occlude the Nares – about ½ only) Use to treat patients recovering from Chronic lung disease
What are the indications for HFNC. What are the liter flows for HFNC What is HFNC able to do?	o Indications:  Alternative form of O2 support for apenic neonates o 1-20 LPM o For oxygenation: Possible Peep like effect maybe 2 cmH20 o Ability to Washout Anatomic Deadspace
What are the indications for CPAP (Bubble or Nasal) 4 indications	• Bubble CPAP or Nasal CPAP o Indications:  Apnea of Prematurity  Premie with Minimal RDS after delivery  After intubation with surfactant administration  RDS after extubation
What are the indications for intubation for neonates and peds? 6 indications	o On CPAP with Pa02 <50 with Fi02 >60 o Frequent apnea despite being on CPAP and medcations o Prolonged apnea events o Deteriorating gas exchange o Administration of surfactant o General Anesthesia
Indications for Airway clearance Therapies	Inability to clear own secretions o Acute Lobar Atalectasis Secondary to Mucous Plugging o CF  (No one modality is superior to the other, Choose what works best with the patient except when GERD is an issue) o NMD  Hyperinflation Therapy  Cough Assist  IPV o Lung Abscess
What are contraindications to airway clearance therapies?	Hemopysis Untreated Tension Pneumo Empyema and large plural effusions Foreign Body Aspiration Hemodynamiclly Unstable Fresh Trach Neonates with weak ribs
Complications and Hazards to Airway clearance therapy	• Hypoxemia o Position Changes o Percussion leading changes in mucous positions altering gas exchange o Atelectasis pushing out of FRC or causing large pressure changes in the lungs o Bronchospasm o Increased O2 consumption o GERD Airway Obstruction from foreign body entering the lungs Intracranial Complications/ IVH in newborns Rib Fracturing and Bruising Airway Trauma
Selection Criteria for ECMO UCSF	• UCSF selection criteria for ECMO o Gestational age >34 weeks o Weight >1.8 kg o Reversible disease o Vent <14 days o Failure of Maximal medical management o Predicted mortality of >80% by historical criteria
Exclusion criteria for ECMO UCSF	• Exclusion criteria o Major intracranial Hemorage o Lethal malformation o Uncontrollable Coagulapathy o Syndrome with poor prognosis o Severe neurological injury
Clinical Indications for ECMO UCSF	• Clinical indications for ECMO o Oxygen index 40 or greater in 2 or more ABG’s o Intractable metabolic acidosis o Intractable shock -Progressive, intractable pulmonary or cardiac failure -Inability to come off cardiopulmonary bypass at operation

RT134 Oxygen Modalities

Indications and Set up for N/C

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