Restrictive diseases

ventilator management of
neonate
case study 
Done by;
Miss: sajooi almarshad
4th level RT student “senior”
 INTRODUCTION

• Baby C was a 31 week male neonate

born vaginally to a 36 year old
mother. Birth weight was 1200
grams. The baby presented with
meconium in the oropharynx.
•
MAS
 CASE PRESENTATION

• Baby C was immediately intubated

and suctioned for a large amount
of meconium. After suction, the
baby was given 100% oxygen and
his respirations were supported.
His 5 minute Apgar score was 5,
with acrocyanosis and grunting
respirations. L/S ratio was 1.5:1
• Is it normal?
•
 Cont.

• Once he was stable, he was

extubated and placed in a oxyhood
with 30% oxygen. After an hour, his
clinical status deteriorated with
increasing respiratory distress
noted. An arterial blood gas
revealed the following
•
 Cont.

pH 7.31
PaO
2 46 mmHg
 PaCO2 42 mmHg
 SaO2 78%
 HCO3 18 mEq/L
 FIO2 0.30 (oxyhood)
CXR
• An hour later, his clinical status
continued to deteriorate, with a
Silverman score of 10. Heart rate
was 160 beats/minute, respiratory
rate was 72 breaths/minute with
audible expiratory grunting.
Arterial blood pressure was 52/29
mmHg
 Cont..
• At this point he was placed on CPAP
at 6 cmH2O and 80% oxygen. ABGs
taken after 30 minutes were:
• pH 7.25
• PaO2 44 mmHg
• PaCO2 50 mmHg
• SaO2 77% HCO3 21 mEq/L
• FIO2 0.80
•
• What will it be ur action
RTTTTTTTTzzz??
• Immediately after these ABGs were
analyzed and reported, the baby
was placed on positive pressure
ventilatory support using the
Galileo ventilator. Settings were:
IMV mode, respiratory rate 40
breaths/minute, peak inspiratory
pressure (PIP) 20 cmH2O, PEEP 4
cmH2O, FiO2 80%.
• What would u recommend more ?
Haa!!
• Two hours later he was given 4.8 mL
of Survanta (dose: 4mL/Kg). His
condition improved over the next
several hours and within 12 hours
after initiation of ventilatory
support
•
• What would u do about ur initial
sittings??
• his FiO2 was weaned down to 40%.
• His condition continued to improve
with no additional complications,
and he was discharged four weeks
postpartum. Upon discharge he
weighed 2000 grams.
•
 Discution TIMMMMMMEEEE


 ^_^
THATSS ITT

• THANQQ 