Factors Influencing Aerosol Delivery to Neonates mjacksonpartners'org http:www'surfneon'com

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Factors Influencing Aerosol Delivery to
Neonatesmjackson_at_partners.org
http//www.surfneon.com
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• Seal
• RN/RT backup
• Documentation of meds
• Practicum maintain a seal/administer med

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• Concentration of aerosol
• Timing with inspiration
• Resistance to distribution of aerosol
• ETT airway diameter
• Inertial impaction of large particles
• Landing patterns of aerosol
• Lung surface area
• Inspiratory time gravitation small particles are
  exhaled
• Particle size
• 0.5 2 microns make it into the lung
• Humidity grows particles

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Capnography (ETCO2) for Assessing Newborn ETT
Placementmjackson_at_partners.org
http//www.surfneon.com
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In one study1 (n9190), success of intubation
attempts was         1st year residents
33         2nd or 3rd year residents
40         Fellows
68         lt20 experiences
37         gt20 experiences
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• 1.        Leone TA, Neonatal Intubation Success
  of Pediatric Traainees, J Pediatr
  2005146638-641
• 2.        Repetto JE, Use of Capnography in the
  DR for Assessment of ETT Placement J of
  Perinatology 200121284-287
• 3.      Aziz HF, The Pediatric Disposable
  End-Tidal Carbon Dioxide Detetor Role in
  Endotracheal Intubations in Newborns J of
  Perinatology 1999 19(2) 110-113
• 4. Li J, Capnography Alone is Imperfect for
  ETT Placement Confirmation During Emergency
  Intubation, J Emerg Med 200120(3)223-229

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• Place sensor turn unit on. Place sensor turn
  unit on. (unit will self-test)Confirm position
  by        CO2 value (ideally gt 20)        CO2
  waveform on monitor

On/off
Respiratory Rate Display
ETCO2 display
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NICO Volumetric CO2
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ETCO2 is less than 100 predictive of airway
position. Figure 1 shows hypothetical data but
is based upon multiple published studies2, 3,
4.   Figure 1.
Figure 1. Sensitivity 94, Specificity
98, P P Value 98 , N P Value 94
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• False positive (tube in esophagus)
• technical error.

• False negative
• (tube in trachea CO2 reading low)
• severe bronchospasm,
• hyperventilation,
• technical error,
• huge leak around ett,
• cardiopulmonary arrest.

Figure 1. Sensitivity 94, Specificity
98, P P Value 98 , N P Value 94
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Skin Care and NeonatalRespiratory DevicesDavid
R. Beadles RRTLise Morrison RRTPat Brady RRT
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Nasal CPAP Fisher Paykel-Primary CPAP
Device-Proper positioning essential Cannulaides A
cts as protective barrier Aids with nasal prong
seal Protects skin integrity at the septum and
nares Mepitac Used as skin barrier under
Cannulaides Atraumatic removal Cavilon vs.
Benzoin What to use?
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Raw skin
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Bruised Nasal Septum /Mepitac use under Cannulaide
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Cannulaide placement
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Cavilon
The Holy Grail?
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Cavilon vs. Benzoine   Endo Tracheal tube
retapings June 2005 vs. June 2006   June 2005
(Benzoine) of ETT retapes - 53 of ventilator
days - 158 33.5  about 1 endo-tracheal tube
retaping every three days   June 2006
(Cavilon) of ETT retapes - 22 of ventilator
days - 69 32 about 1 endo-tracheal tube retaping
every three days  
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CPAP Devices ETT holders Tape
Whats down the Road?