2004 OPEN FORUM Abstracts
Infant Response to Monitoring of lung Sounds in the Newborn ICU: ElECTRONIC-REMOTE VS Stethoscope
Michael
R. Jackson NPS-RRT CPFT – Brigham & Women’s Hospital,
Boston, MA, Andrey Vyshedskiy, PhD - Faulkner Hospital, Boston,
MA, Anna Wong NPS-RRT CPFT RN - Faulkner Hospital, Boston, MA, Paul
Nuccio RRT FAARC - Brigham & Women’s Hospital, Boston, MA
Background: Auscultation
of infant lung sounds may cause them disturbance & introduce
infection. That disturbance may compromise the patient’s well
being. The infant’s agitation may effect the quality of
breath sounds. Bedside nurses may try to protect the babies
environment by limiting RT access to the patient. We wondered if
breath sounds could be monitored without disturbing the infant.
Methods: Twenty
events of lung sound auscultation were monitored. Half were
monitored by stethoscope and half by pre-placed electronic biological
sound sensor. Each patient served as their own control. No patient
was auscultated unless the normal care plan called for it. Wires from
these sensors ran to the outside of the infant’s isolette,
where they connected to the auscultation device. Five mechanically
ventilated breaths were monitored. Infant motor response was
assessed by NIDCAP trained nurses before during and after sound
auscultation. Respiratory Therapists monitored for changes in
ventilator synchrony (per waveform monitoring) and O2 saturation (per
pulse oximetry). Infant state (wakefulness) and attention related
responses (eg. fussing,) were not documented.
Results: Results
showed that stethoscope auscultation had significant effect on infant
O2 saturation, autonomic (ventilator synchrony) and motor response.
Remote sensing of sounds was associated with no obvious response by
the patient.
Conclusions: Contact
of the (often cold) stethoscope disturbs the patients sleep pattern,
& causes O2 desaturation, agitation of the patient, effects the
breathing pattern & ventilator synchrony. A breath sound
monitoring system may be placed on an infant so that the infant state
is not disturbed and sound may thereby be more effectively analyzed.
The electronic system tested cost $250 for the monitor and $5 each
for the sensors. A reusable conventional stethoscope (dedicated to
individual patient) may be purchased for ~$70.
*
NIDCAP – Newborn Individualized Developmental Care and
Assessment Program provides a neurologic assessment system for
newborns.