WHEN and HOW do we use the NEONATAL High Frequency Jet Ventilator!!!
ฝัง
- เผยแพร่เมื่อ 25 ก.ค. 2024
- PART II on jets!! WHEN do we USE the jet ventilator? What settings do we START babies on? What settings do we change if the gas shows an elevated C02? What about if we have a pneumothorax? What if the baby's oxygen is dropping? Should we always be using the jet for tiny premature infants? What evidence do we have? Learn the answers to all these questions in this video! PART II of our JET series.
A massive THANKS to Bunnell (bunl.com/) for helping us with so many educational materials for this video (and especially to Kari Neville BSRC, RRT-NPS, FAARC who couldn't have been more responsive and helpful!)
This video was NOT sponsored.
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
Rallis D, Ben-David D, Woo K, Robinson J, Beadles D, Bernardini L, Abdulhayoglu E, Flanigan E, Christou H. Single center experience with first-intention high-frequency jet vs. volume-targeted ventilation in extremely preterm neonates. Front Pediatr. 2024 Jan 4;11:1326668. doi: 10.3389/fped.2023.1326668. PMID: 38239592; PMCID: PMC10794594.
Sindelar R, Nakanishi H, Stanford AH, Colaizy TT, Klein JM. Respiratory management for extremely premature infants born at 22 to 23 weeks of gestation in proactive centers in Sweden, Japan, and USA. Semin Perinatol. (2022) 46:151540. 10.1016/j.semperi.2021.151540 - DOI - PubMed
Elgin TG, Stanford AH, Klein JM. First intention high-frequency jet ventilation for periviable infants. Curr Opin Pediatr. (2022) 34:165-9. 10.1097/MOP.0000000000001104
Ganguly A, Makkar A, Sekar K. Volume targeted ventilation and high frequency ventilation as the primary modes of respiratory support for ELBW babies: what does the evidence say? Front Pediatr. (2020) 8:27. 10.3389/fped.2020.00027
Rojas-Reyes MX, Orrego-Rojas PA. Rescue high-frequency jet ventilation versus conventional ventilation for severe pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev. (2015) 2015:CD000437. 10.1002/14651858.CD000437.pub3
Collins JJP, Tibboel D, de Kleer IM, Reiss IKM, Rottier RJ. The Future of Bronchopulmonary Dysplasia: Emerging Pathophysiological Concepts and Potential New Avenues of Treatment. Front Med (Lausanne). 2017 May 22;4:61. doi: 10.3389/fmed.2017.00061. PMID: 28589122; PMCID: PMC5439211.
Söderström F, Normann E, Jonsson M, Ågren J. Outcomes of a uniformly active approach to infants born at 22-24 weeks of gestation. Arch Dis Child Fetal Neonatal Ed. 2021 Jul;106(4):413-417. doi: 10.1136/archdischild-2020-320486. Epub 2021 Jan 15. PMID: 33452221.
Yanagisawa T, Nakamura T, Kokubo M. Prognosis of 22- and 23-Gestational-Week-Old Infants at Our Facility: A Retrospective Cohort Study. Am J Perinatol. 2022 Mar 11. doi: 10.1055/a-1779-4032. Epub ahead of print. PMID: 35193151.
Watkins PL, Dagle JM, Bell EF, Colaizy TT. Outcomes at 18 to 22 Months of Corrected Age for Infants Born at 22 to 25 Weeks of Gestation in a Center Practicing Active Management. J Pediatr. 2020 Feb;217:52-58.e1. doi: 10.1016/j.jpeds.2019.08.028. Epub 2019 Oct 9. PMID: 31606151.
Respiratory Distress Syndrome of the Newborn Infant - Scientific Figure on ResearchGate. Available from: www.researchgate.net/figure/C...
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**TIMESTAMPS**
00:45 When do we use the jet?
05:47 Initial Settings using a jet ventilator
10:58 How to titrate jet based on clinical scenarios
11:21 How to titrate jet when CO2 too high
14:38 How to titrate jet when nfant hypoxemic
16:06 How to titrate jet when infant has a high C02 and lungs are HYPER-expanded
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.
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Another amazing video! Thank you Dr Tala. I’m a NICU RN from California ❤
I’m so glad you found it helpful Teresa! Thank you! And thanks for letting us know where you’re from- lucky you! California!
Thank you for the video, it is really helping me understand the Jet better. Could you also do a video explaining the NAVA?
Hello!!! I’m so glad this video helped!! We really need to cover NAVA- I will say we don’t use it as much in our unit so I don’t feel like I have practical understanding of it- maybe I need to find an expert!!!!!
Very helpful, thank you! Primary Childrens Hospital in SLC UT, NICU level 4
So glad you thought so! I bet your unit is super busy too! Thanks so much for taking the time to comment!
Loved the video! Could you make a video on online auction while on the ventilator ?
Yes! That would be a fantastic video- setting up help with an RT friend of mine and we’ll get it covered :) thanks for being here!
I'm in Respiratory Therapy school and your videos have been very useful! Thank you Dr!
Hello- so glad you've found them helpful at all- thanks so much for letting us know :)
I say you are reflector of goodness of God. May God bless you with His love.
Thank you so much XX
Another fantastic video! - from Utah, USA
Thank you so much Daina :)
Evanston Hospital, ISCU Respiratory Care - IL
We utilize all - conventional vents, HFJV & HFOV. (w/ or w/o iNO)
We love tiny humans.❤
Thx Dr. T!
Love tiny humans! That’s so great you get to play - and trouble shoot!- all the machines! So happy you’re watching! Thank you!
Thank you so much ❤ never used the jet but now I feel somehow comfortable to the name
From Libya 🇱🇾 ❤
Oh that makes us so happy!!!! Thank you so much for subscribing and for taking the time to write such a lovely comment :)
I am from losangeles good information
Thanks and welcome!!!!
Thank you! NICU in Chester county hospital west Chester PA USA
Oh yay! Thanks so much for watching and for letting us know :)
Came in clutch
HAHA! Love it when that happens- have a long boring story about how I learnt some critical piece of information from the show E.R when I was in med school. Was the most clutch thing ever! ha!
I am nicu RT from Losangeles thanks for the great video
Hello! We’re so glad you find it helpful! Thanks for being here!!!
Thank you so much for taking the time to comment! So happy you find the videos helpful!
QUESTION: whats the difference between a jet with sigh breaths and the VDR?
Hello! I had barely read about the VDR ventilator before and have never used it. I tried reading up more and see it has been useful in adults with ARDS and post cardiac surgery- from what I can tell it’s more like conventional vent with superimposed high frequency settings used mostly for secretion clearance (and hopefully less damage). The conventional rates etc are generally higher as are the I times. With the jet- its baseline high frequency and can rarely add on a CMV. Here is the article I was reading- maybe you can add more? apps.dtic.mil/sti/pdfs/ADA629373.pdf
❤
THANK YOU :)
Dr. Tala, greetings from the country of Georgia. It's my first year in neonatology residency, and you have been helping me a lot. Thank you very much.
Hello doctor! So happy you found these helpful at all!!!we hope you love your training! Let us know if there’s something you think we should film!’
I gave birth 10 days ago to twins born at 28 weeks. My boy in the last few days has developed a bacteria infection. The drs told me it’s Ecoli. His markers are going down with antibiotics and they will extend the antibiotic dosage to 14 days as a precautionary measure for potential meningitis.
I would like to know how he could have gotten Ecoli in a NICU unit, how common that is and how easily treatable it is? Thanks in advance
First - congratulations on your babies!!! I'm sorry they were born early and you're dealing with a NICu course, but it's good to know they're getting better. E. coli is the most common bug that premature infants get. We naturally have it in our guts and babies will often have it within their intestines too. With weak immune systems and GI systems - it's not uncommon for infants to become septic- most commonly with E. Coli. It sounds like your NICU caught it early and things are going well. Stay strong mama- we wish your family health and love XX
New york
Lucky you! Thanks for letting us know!