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Babies requiring sustained respiratory support

Respiratory support treatment in Hebbal, Bangalore

Infants born preterm tend to have deficient surfactant and immature lungs, with small surfaces and thick air-blood barriers. Therefore, preterm infants often require respiratory support at birth by providing respiratory support treatment in Hebbal, Bangalore, particularly those born before 29 weeks. The following types of respiratory support are provided to those babies,

  1. Oxygen

  2. CPAP (Continuous Positive Airway Pressure)

  3. NIPPV (Noninvasive Positive Pressure Ventilation)

  4. Mechanical Ventilation

  5. ECMO (Extracorporeal Membrane Oxygenation)

As needed, mild tactile stimulation, head positioning, and suction of the mouth and nose are used in the early stages of stabilisation.

Oxygen: It is possible to administer oxygen with a nasal cannula or a face mask. Preterm infants should have an oxygen saturation of 90 to 94%, and term infants should have an oxygen saturation of 92 to 96% for optimal oxygen concentrations. Keeping PaO2 high in infants increases the risk of prematurity retinopathy because fetal haemoglobin has a higher affinity for oxygen. To prevent bronchospasm, oxygen should always be warmed (36 to 37°C) and humidified when delivered.

Continuous Positive Airway Pressure: CPAP maintains a constant pressure, usually 5 to 7 cm H2O, throughout the respiratory cycle but does not support inspiratory pressure. The infant breathes spontaneously with CPAP to keep alveoli open and improve oxygenation. An endotracheal tube connected to a conventional ventilator with a zero rate can also give CPAP using nasal prongs or masks and various apparatuses to provide positive pressure.

Noninvasive Positive Pressure Ventilation: NIPPV uses nasal prongs or masks to deliver positive pressure ventilation. Infants' inspiratory effort can trigger synchronised or non-synchronised. NIPPV can supplement an infant's spontaneous breathing, which provides a backup rate. It is possible to set the peak pressure to the desired level. It helps prevent atelectasis in patients with apnea and facilitates extubation. There has been no effect on the development of chronic lung disease or mortality with NIPPV; however, it reduces extubation failures and re-intubations more effectively than nasal CPAP within one week.

Mechanical Ventilation

Mechanical ventilation requires endotracheal tubes (ETT).

Ventilation modes:

  • Synced intermittent mandatory ventilation (SIMV)

  • Assistance with ventilation (AC)

  • Oscillatory ventilation at high frequencies

The ventilator delivers a predetermined number of fixed-volume or fixed-pressure breaths during SIMV. These will not only synchronise with the patient's spontaneous breaths but will also give breaths with no respiratory exertion. The patient can breathe on their own without triggering the ventilator.

Each time a patient inhales, the ventilator delivers a predetermined amount or pressure of air. A backup rate is set when a patient does not take enough or has no breaths.

High-frequency oscillatory ventilation can be used in infants with a set mean airway pressure (400 to 900 breaths/minute). It is often preferred by highly premature infants (28 weeks gestation) and infants with air leaks, widespread atelectasis, or pulmonary oedema.

Extracorporeal Membrane Oxygenation

ECMO is used when conventional or oscillating ventilators cannot adequately oxygenate or ventilate babies with respiratory failure. The eligibility criteria vary by centre, but infants with reversible conditions (e.g., congenital diaphragmatic hernias, persistent pulmonary hypertension of the newborn, overwhelming pneumonia) must have been on mechanical ventilation for at least seven days. Another indication for ECMO is primary cardiac compromise.

In an artificial lung, blood is pumped through a membrane oxygenator after administering systemic anticoagulation. ECMO uses either the internal jugular vein (venovenous ECMO) or the carotid artery (veno arterial ECMO) to circulate oxygenated blood back to the heart. In overwhelming sepsis, veno-arterial ECMO is used for circulatory and ventilation support. You can adjust the flow rate to achieve the desired saturation and blood pressure.

Due to the risk of intraventricular haemorrhage associated with systemic heparinisation, ECMO is contraindicated in infants over 34 weeks or 2 kilograms. Book an appointment at Manipal Hospitals now.

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