2011 OPEN FORUM Abstracts
NASAL RESPIRATORY SUPPORT (NARES) VIA THE NARES USING NEOTECH RAM NASAL CANNULA IN NEWBORN INFANTS WITH RESPIRATORY DISTRESS: NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE [NCPAP] OR NASAL CANNULA-INTERMITTENT MANDATORY VENTILATION [NC-IMV] FROM DELIVERY ROOM TO DISCHARGE.
Richard Hernandez1, Rangasamy Ramanathan2; 1Newborn Respiratory Care, LAC+USC HealthCare Network, Los Angeles, CA; 2Division of Neonatal Medicine, LAC+USC Medical Center, Los Angeles, CA
Background: NARES (NCPAP or NC-IMV) is increasingly used in newborn infants either as a primary mode or following extubation from mechanical ventilation via the endotracheal tube to minimize lung injury as well as ventilator associated pneumonia (VAP). Nasal interfaces currently used are cumbersome to set up, difficult to provide Kangaroo care, and is associated with a significant risk for short- and long-term nasal injury/deformities. We report our experience using Neotech RAM Nasal Cannula in the delivery room and in the newborn intensive care unit to deliver NARES as well as Nasal High Frequency Oscillatory Ventilation (NHFOV). Methods: We used conventional ventilators (Avea, Servoi, Bear Cub) and Sensormedics HFOV to provide NARES. Ventilator specific guidelines were developed and used during NARES. We used 3 different sizes of NC (2.0 mm. 2.5 mm, and 3.0 mm ID) for this study. Patients received feedings via orogastric tube per NICU protocol. Results: Twenty two preterm and term newborns (Birth weight 635-4100 g, Gestational age 26-41 weeks, postnatal age 1-124 days) were managed on NARES using the Neotech RAM NC. Mean airway pressure prior to initiating NARES ranged from 7-13 cm H2O. Blood gases before and after initiation of NARES was similar, with no deterioration in oxygenation or ventilation. Number of desaturation episodes was similar or decreased following NARES. One patient with bronchopulmonary dysplasia (BPD) was successfully managed on NHFOV and subsequently weaned off to low flow NC. No case of VAP or nasal injury was reported in our experience. No cases of feeding problems were reported during NARES. Conclusions: NARES using Neotech RAM NC can be used safely and effectively either as a primary mode for neonatal resuscitation in the delivery room or following a period of mechanical ventilation via the endotracheal tube. Additional studies to evaluate the usefulness of NARES using Neotech RAM NC in the delivery room as well as its impact on BPD are needed and are underway. Sponsored Research - None