Mechanical ventilation & intubation for neonates

1. Mechanical Ventilation & intubation for Neonates
Students
Zaeid Alhamashi
Mohammed Rikan
Raheem Tosin

2. Preterm
27%
Sepsis&
pneumonia
26%
Asphyxia
23%
Tetanus
7%
Congenital
7%
3%
Diarrhoea Others
7%
4 millionneonatal deaths:When?Where?Why?Lancet 2005; 365: 891–900

3. ADULTvs. NEONATALRESUSCITATION
 Thesequenceof resuscitation in adults is C-A-B
 But in newbornsthe sequenceremains
A-B-Casthe etiology of neonatal compromise is
nearly always abreathingdifficulty
 AIRWAY(position andclear)
 BREATHING(stimulate to breathe)
 CIRCULATION(assessHR and oxygenation)

4. Assessbaby’s risk for requiringresuscitation
Provide warmth
Position, clear airway ifrequired
Dry, stimulate to breathe
Give supplemental oxygen, asrequired
Assist ventilation with positive
pressure
Intubate thetrachea
Provide chest
compressions
Medications
Always needed
Neededless
frequently
Rarelyneeded

5.  Low muscletone
 Respiratory depression
(apnoea / gasping)
 Tachypnea
 Bradycardia
 Hypotension
 Cyanosis

6. Oral mucussucker
SuctionCatheter
Radiantwarmer

8. Provide warmth :
Radiant warmer,don’t
cover with towels.
Position headand
clear airway as
necessary
Dry and stimulate
the baby to breathe,
reposition

10. Suction mouth first,then
nose
“M” before“N”
Toprevent aspirationof
mouth contents

11. Free flow oxygen
 Oxygen mask
 Flow inflating bag
 T- pieceresuscitator
 Oxygen tubing held
close to baby’s nose
CPAPprovided with
 Flow inflating bag
 T-piece resuscitator
Start with room air and
increase to maintain
target SpO2
Time Target Spo2
1min 60-65%
2min 65-70%
3min 70-75%
4min 75-80%
5min 80-85%
10min 85-95%

13. MASK
Flow InflatingBag
T-PieceResuscitator

14. Ventilation of the lungs is the
single mostand most effective
step in newbornresuscitation
Indications:
Gasping/apnea
HR<100/min
SpO2 remains below target
values despite free flow
supplemental oxygenincreased
to 100%.

15. Peak inspiratory pressure(PIP) : Pressure
delivered with each breath, such asthe
pressure at the end of asqueeze of
resuscitation bag or at the end of breath with
aT–pieceresuscitator
Positive end –expiratory pressure(PEEP):
Thegaspressurewhich remains in the system
between breaths, such asduring relaxation
and before the next squeeze

16. Continuous positive airway pressure(CPAP):
Same asPEEP,but used when the baby is
breathing spontaneously andnot receiving PPV.
It is pressure in the system at the end of
spontaneous breath when amask is held tightly
on baby’s face but the bag is not being
squeezed.
Rate: Thenumber of assistedbreaths given per
minute

17. Most Important sign is the rising of HR
Improvement in OxygenSaturation
Equalandadequatebreath sounds B/L
Good Chestrise

18. Heart rate
Oxygenation by
oximeter
Ifheart rate <100 bpm

19. If heart rate <60 bpm
despite adequate
ventilation for 30
seconds,

20. Indications :
HR<60/min
despite atleast
30secof
effective PPV
Strongly considerEndotracheal intubation atthis point
asit ensuresadequate ventilation and facilitates the
coordination of ventilation and chestcompressions

22.  WHENTOCONSIDERINTUBATION ?
Indications inresuscitation
 Baby is floppy, not crying, and preterm
 HR<100/min, gasping/apnea
 HR<100/min inspite ofPPV
 HR<60/min
 No adequate chest rise and no clinical
improvement
 If chest compressions are needed, intubation
provides better coordination and efficacy of PPV
 Toadminister drugs

23.  WHENTOCONSIDERINTUBATION ?
 Specialconditions
 Meconium aspiration if baby is depressedin
which it is the first step to be done
 Extreme Prematurity
 Surfactant administration
 Suspected diaphragmatichernia

25. Watching the tube passing between cords
Watching for chestmovements
Listening for breath sounds(Axilla and stomach)
Colourimeter/Capnography (Canalso be usedfor PPV
with mask orLMA
Improvement in HRandSpo2
Vapour Condensing insidetube

26. Mechanism of action:
Increases systemic vascularresistance
Increases coronary arteryperfusion pressure
Improves blood flow to myocardium and
restores depletedATP
Indications :
If HR remains < 60/min even after 30secof
effective ventilation preferably after intubation
and atleast another 45-60 secof coordinated
chest compressions and effectiveventilation

27. Administration :
Intravenous (recommended)
Endotracheal
Preparation anddosage:
Adrenaline vial1ml =1mg (1:1000 solution)
Dilute with NSto make1:10,000solution (1ml =
100mcg)
Canrepeat every 3-5minutes

28. Doing the simple things better is probably the
most cost-effectivepolicy.
Resuscitation can come ascompletesurprise
Sobe prepared forresuscitation.
It may take severalhours to learn but it
should be implemented over seconds.
Practice makes oneperfect.