Two neos chat!!// All about neonatal ventilation!!
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- เผยแพร่เมื่อ 6 ต.ค. 2024
- The JET?!! Oscillator?! VOLUME guarantee ventilators?! Pressure control modes?!! Dr. Sridhar and Dr. Tala have a casual conversation about the advantages/disadvantages of all the different ventilator modes we use in the neonatal intensive care unit. What IS volume guarantee ventilation? Has any ventilator proven to decrease BPD? What does synchronization mean??!!! We discuss what we use in the our units and why!!! Please let us know what you use in YOUR units!!
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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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*Disclaimer*: This video is intended for educational purposes only and while
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A respiratory therapist by profession, very interesting conversation. The problem with early extubation is that the elb babies have frequent hypoventilation, even apnea and then we become impatient and reintubate them, with septic screening exposing them to unnecessarily antibiotics. Why we expect a 24 weeker to breathe normally. Do you experience these in your practice
Hello! Excellent point! I think we’re all learning that the smallest babies don’t necessarily do better with early extubation. Those 24 weekers are funny too- they can act like 26 weekers or like 23 weekers. I think we’re definitely in a stage where we need to think about each baby separately. I’m always nervous about pulling the tube when the tiny babies are in their honeymoon stage- and then a couple of days later they collapse and need high settings on the vent (especially that first week of life when they’re at most risk for an IVH). So yes- all great points. Thank you for bringing this up
You might find this helpful Approach to extubation in the NICU focusing on preterm babies #nicu #preterm #extubation
th-cam.com/video/Yrhrcj5LPcw/w-d-xo.html
Good but hope less short forms are used @ Dr Sri
It gets confusing
Agree! We just chat- so it’s super easy but we don’t know where the other person is going so less organized! We enjoy it ourselves! Ha!
Wonderful. Thank you ! long live these collaborations.
We’re loving doing them Donald- thank you!!!
Thank you so much dr Tala to share wih with dr sridhar i am So happy for that. Please i need for more videos for how to resucitate extreme preterms with intubation videos
Thank you so much for watching! We’re putting out an intubation video soon!!! Thank you!!
Thanks ever so much again ... I think I should always tune in to your discussions as always.. I'm a novice at NICU and I need more and more of these ❤😊
Oh thanks so much- we're so happy you find these helpful! We need to set another one up soon!
Love your videos. Could you do a video that is all about NAVA ventilation as well? 🙂
Hello! This is definitely something we need to cover- and I worked in a unit where we used it quite consistently but I haven’t in a few years. So maybe I need to find someone with more recent experience to do this talk!! We’ll look around!!!
Thank you so much ❤… you are awesome in such discussions
Q/ which is better weaning mode or safer in premis … SIMV vs PTV?
Honestly- I think the answer is what you and your unit is comfortable with. If you’re in volume mode and targeting low volumes (4-5ml/kg) and the machine is delivering low pressures to achieve this volume- (and X-ray ok, good fio2 etc) then you can probably try to extubate. With pressure control- you’re steadily lowering the pressure until you feel good about it. So vague! Maybe we should discuss just extubation!
Great discussion!
What is your preferred mode of ventilation on the conventional mechanical ventilation when Vg doesn’t seem to be working.
It would be great if could share some thoughts on those other modes including rationale, especially PC-AC mode.
Thanks
Thank you so much for listening! Trying to set up a way to go through the different modes of ventilator usage- they’re all pretty similar. We would use pressure control/ support mode. Ie a delivered rate giving a set pressure and then the spontaneous breaths would get a lower pressure (ie to support these breaths). We can then wean the pressures and the rates. We’ll try to set that up soon!
@@TalaTalksNICU I think SIMV is more flexible in supporting neonates and can manage hyper apnea better with vent rate
Sorry hypercapnea
Please can you talk to us about the best NICU reference book to study and your advice?
Yes! We’ll put a video out soon on this! Thank you for a great suggestion!
I am a general pediatrician practicing in Malawi Africa. In our hospital we only have conventional ventilators, no volume or pressure guaranteed options. Currently no surfactant. How can we ethically manage preterms and when can we ethically stop care and let nature takes its course as we are handicapped in terms of equipment, medication and professionals.
Hello! This is such a great question and one that I think we talk about even in developed countries. At what point is the chance of an acceptable outcome so bad that we should stop? I’m guessing when there are fewer resources there is an emphasis on what can be done- eg do you give steroids to mothers in preterm labor? Do you have CPAP available? You can ethically manage babies because you are doing the best you can with what you have available- which is what we’re all doing on some level
@@TalaTalksNICU yes we give steroids, yes we have CPAPs,
You might find this helpful Approach to preterm care in developing countries. Focus on ethics. Dr Sridhar Kalyanasundaram
th-cam.com/video/Jg1nwre6ujg/w-d-xo.html
Interesting, thanks so much
But I would like to know what is the difference between delta p And p max in VN Drager ventilator?
Hello! Not sure which ventilator exactly you’re referring to- but the delta p is always the difference between the PIP and PEEP and Pmax is the maximal pressure used on the baby. Generally we use Pmax when we’re giving volume guaranteed breaths and we don’t want the machine exceeding certain pressures! Does that answer the question!?
Thanks, Docs!
Thank you for watching!
Thanks so much for the information. Is there any video on ventilator graphs pls
Hello linahzulu! So glad it helped- we are trying to get a video done by using the ventilators in the hospital. Trying to sort out logistics!!
Please review this Graphics and waveforms in neonatal ventilation #ventilation #graphics #waveforms #nicu
th-cam.com/video/e4pPMCPUMK0/w-d-xo.html
very informative ,thanks for clear explanation
Thank you so much for watching/ we really appreciate you being here
Awesome. Nicely explained ❤
Thank you so much for your lovely comment!
I love your input dr Tala
Thanks so much Lynette- and thanks for subscribing! I've been loving these chats!
Very nicely explained, as always
Thank you so much- for watching and for writing to us :)
What's jet ? Is it a ventilator ? WE don't use it in Tunisia
Yes! It’s a high frequency ventilator- not ever unit uses them here either. It’s all about getting used to your own type of ventilator and doing the best you can for the babies!
@@TalaTalksNICU thank you for all the informations .... WE use leoni plus ventilators and cpap.
please send your telegram link
I’m not really on telegram! My friend Dr. Sridhar is very active on telegram and I’ve joined his. I tried going back to account but can’t find now!!! Sorry! Not helpful at all!