2005 OPEN FORUM Abstracts
CASE STUDY: A REVIEW OF NeoPAP® IN A POST 24 WEEK NEONATE WITH CHRONIC LUNG DISEASE (CLD) AND MILD EDEMA.
Betty Blake, B.S., RRT, NPS, Shannon Poling, B.S., RRT, and Lee Woods, MD, PhD. The Johns Hopkins Hospital, Baltimore, Maryland.
Introduction: A case study presenting the efficacy of NeoPAP® in a post preterm infant with CLD.
Case Study: The neonate now 3 months of age presents with CLD, mild edema, hydrocephalus and other congenital anomalies was on a nasal cannula (NC) of 2 liter per minute (LPM) at .40 of Oxygen (O2). The neonate developed atelectasis in the right lung that was not responsive to Albuterol treatments and Chest physiotherapy. The Chest X-ray (CXR) on NC of 2 lpm showed complete atelectasis of the right lung with a shift of the medistinal structures to the right. The respiratory rate was 54 breaths per minute(bpm). The capillary blood gas (CBG) was ph 7.35/ PCO2 53/ PO2 39 and HCO3 28.6. We placed the neonate on NeoPAP® with Continuous Positive Airway Pressure (CPAP) of +5. After a period of fourteen hours on the NeoPAP® the CXR showed that the right lung has re-expanded. The CBG was pH 7.40/ PCO2 54/ PO2 39 and HCO3 32.0. The respiratory rate was 53 bpm. The neonate remained on NeoPAP® for 48 hours and then was weaned back to NC of 1 lpm. The neonate's CBG's and respiratory rate remained stable throughout the NeoPAP® trial and on the subsequent NC. (See Chart)
|Date||Respiratory Support||CXR Results||Capillary Blood Gas|
|4/18/2005||NC 2 lpm||Complete atelectasis|
|4/19/2005||NC 2 lpm||Right lung opaque||7.35/53/39/28.6|
|4/19/2005||∆ NeoPAP® +5||7.40/54/39/32.0|
|4/20/2005||NeoPAP® +5||Right lung reaerated||7.37/47/48/27.0|
|4/21/2005||NeoPAP® +5||Both lungs no atelectasis||7.37/47/48/27.0|
|4/21/2005||NC 1 lpm||Lungs well aerated|
Discussion: NeoPAP® has electronically controlled proportional solenoids to provide accurate control of target pressures to help reduce the work of breathing. The Baby Trak Technology helps provide stable CPAP pressures with the introduction of leaks or in variable breathing patterns. The advanced heated humidity provides increased patient comfort with less rainout. Within hours of initiating the NeoPAP® the neonate's right lung was re-expanded per CXR. The neonate's respiratory rate stayed within the normal limits. The neonate's CBG's remained stable. The patient appeared to be comfortable. The neonate was able to be transported to radiology while still on NeoPAP®, allowing consistent respiratory support.
Conclusion: This particular case demonstrated that NeoPAP® can provide sufficient CPAP to aid in the re-expansion of collapsed lungs without diminishing patient comfort.