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RSPT 2353 – Neonatal/Pediatric Respiratory Care
O2 Therapy for the Neonatal/Pediatric patient
Lecture Notes
Reference & Reading: Czverinske, Chapter 12
I. INDICATIONS
A. According to AARC guidelines O2 therapy in this pt population, there are two situations in which O2 therapy is called for:
ü documented hypoxemia
ü an acute situation in which hypoxemia is suspected or in which suspected regional hypoxia may respond to an increase in PaO2
B. Larger infants & Child
C. Neonates
II. CLINICAL SIGNS AND SYMPTOMS
A. Early signs of hypoxia
B. Worsening hypoxia
C. Other physical signs include
D. In the neonate or infant, the patient may become lethargic or flaccid and assume a “frog leg” position
E. Fetal Hb
F. Central v. Peripheral
G. Frequent short periods of apnea
H. Acidosis or hypercapnea
III. GOALS OF O2 ADMINISTRATION
A. PaO2
B. The smaller the child the lower the PaO2, but we must monitor for the presence of apnea and bradycardia to fine tune O2 delivery
C. If the patient is in Persistent Fetal Circulation, a PaO2 of 100 torr may be required to get pt out of the state.
IV. COMPLICATIONS FROM O2 ADMINISTRATION
A. Hypoventilation
B. Retinopathy of Prematurity - Oxygen’s contribution to Retinopathy of Prematurity is controversial.
1. Increased O2 levels
2. Other factors that contribute include
3. PaO2 levels
C. Absorption Atelectasis
D. Pulmonary fibrosis
V. METHODS FOR O2 DELIVERY –
A. OXYHOOD – This is the device of choice for the preemie or newborn in the first days of life.
B. Parts of the oxyhood
1. Oxyhood
2. Blender
3. Heater
4. Temperature probe/thermometer
5. Calibrated O2 analyzer
C. Adapting an Oxyhood –
1. Lack of Blender
2. Lack of Heater
D. TROUBLESHOOTING THE OXYHOOD
1. Low SpO2?
ü Check pt
ü Check pulse ox
ü Check FiO2, and flow rate
2. Low FiO2 reading on analyzer?
ü Check blender setting
ü Check placement of analyzer probe
ü Check placement of hood
ü Check for disconnections
3. Excessive temperature?
ü Check heater setting
ü Check water level of humidifiers
ü Check flow rate
4. Low temperature?
ü Check heater setting
ü Check flow
ü Check for disconnection
VI. NASAL CANNULA – This device, just as in adults, is used for prolonged supplemental oxygen delivery. It is attached to a cool bubble humidifier.
A. Placement
B. Flowmeters
C. Determining FiO2: Because an infant’s Ve is so low, the FiO2 at any given flow differes drastically from the FiO2 of an adult NC. Infants are at risk for swallowing air on a NC if the flow rate exceed the pt’s Ve.
ü If your infant weighs 3 kg, his predicted Vt is 30 cc and respiratory rate is 60 bpm his Ve is :
Vt x RR = Ve
.03 x 60 = 1.8 lpm
Administration of 2 lpm via NC might blow excess gas into his stomach.
D. Estimated FiO2 for NC at several flow rates:
ü ¼ lpm 24% - 27%
ü ½ lpm 26% - 32%
ü 1 lpm 30% - 35%
* This is an estimation, smaller babies will receive higher FiO2 at a lower flow rate because their inspire Ve is lower.
E. Monitoring
F. Vapotherm
VII. TENT HOUSE OR HUT
A. Indication
B. It fits over the head and shoulders of the patient that is larger but can’t sit up or roll
C. Powered by cool aerosol at flow rates >15 lpm, and uses an entrainment device
D. Monitor FiO2 with an O2 analyzer, and use SpO2 and blood gases to monitor the pt.
VIII. MIST TENT
A. Indication
B. Disadvantage
C. The mist tent can deliver between 21% and 50% FiO2
IX. O2 MASK
A. The O2 mask (simple, venturi, or NRM) is not an ideal choice for the infant in that it can obstruct its airway.
B. Blow by
C. As the pt reaches 3 years of age, she might tolerate a mask, but the NC is still the preferred methods for O2 delivery
D. As with the adult pt, the venturi mask is the only method of exact FiO2 delivery because it is a high flow device.