Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.
-
Upload
winfred-watson -
Category
Documents
-
view
215 -
download
0
Transcript of Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.
![Page 1: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/1.jpg)
Presented By :
Dr. SUBHASIS ROY , CONSULTANT, SISU SANJIBAN HOSPITAL ,
SALT LAKE , KOLKATA
![Page 2: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/2.jpg)
THE HISTORY
1774 – J. Priestly produced O2 – “Dephlogisticated Air”
1776 – A. L. Lavoisier termed this vital air – OXYGEN
Late 1800 – Bonnaire gave O2 to preterm “Blue Baby”
with success .
1907 – A. Lane invented NASAL CATHETER
1919 – L. Hill developed O2 TENT.
1920 - O2 therapy became routine for “SICK NEW BORN”
![Page 3: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/3.jpg)
O2 THERAPY IN NEONATE VS OLDER CHILDREN
In Neonate –
O2 reserve less
O2 requirement / kg. higher.
Small change in Fi O2 – large change in Pa O2
Unrestricted O2 therapy – produce pulmonary / extra
pulmonary hazards.
MORE CAUTION REQUIRED IN NEONATAL O2 THERAPY
![Page 4: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/4.jpg)
NEW BORN RESUSCITATION – HOW IMPORTANT O2 IS
CURRENT RECOMMENDATION – 100% O2 IN NRPBUT
A GROWING OPINION THAT RA CAN BE USED IN PLACE OF O2
Approx 100 million babies born annually, globally
- 10 million need resus ! . Cochrane review :
RAR group shorter time to first breath and first cry.RAR group – only 25% required 100% backup O2 facility.RAR group – Marginally lower overall mortality.No evidence of HARM in using RA
BUTINSUFFICIENT DATA TO RECOMMEND RA OVER 100% O2
NEW BORN RESUS. IS A SCIENTIFIC PROTOCOL BUT MORE AN “ART”THAN A “SCIENCE” IN DEVELOPING COUNTRIES WITH RESOURCECONSTRAINTS. NOT TO PANIC IF O2 SUPPLY IN LABOUR ROOM IS RESTRICTED OR NOT AVAILABLE.
![Page 5: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/5.jpg)
ASSESSMENT OF NEED OF O2 THERAPY
DURING AND JUST AFTER RESUSCITATION IN NEWBORN
Only clinical – Cyanosis
Heart rate i.e bradycardia
Resp effort
Muscle tone
Response to stimuli
LATER PART OF THE NEW BORN LIFE
Clinical – Cyanosis
Heart rate
Pattern of breathing i.e. apnoea/Periodic breathing
Monitoring - ABG – PaO2 < 50 mm.Hg.
Trans cutaneous oxygen monitoring
Pulse oximetry - SpO2 < 85 %
![Page 6: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/6.jpg)
MODES OF OXYGEN DELIVERY
SOURCE
O2 cylinder
O2 concentrator - max 5 – 8 lit / min. of 90 – 92% O2
Pipeline - Cheapest
![Page 7: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/7.jpg)
MODES OF OXYGEN DELIVERY…
DELIVERY DEVICE
LOW FLOW DEVICE
Nasal Canula – Max flow 2 – 3 lts./min. in new born.
Nasopharyngeal Catheter
Insert a length – Alae nasai to Tragus
Check for blockage with mucus plug
FiO2 difficult to measure/control
Better if changed 24 hrly.
Not more than 3 lit. / min. O2 in new born
Every lit. of O2 - FiO2 by 4
![Page 8: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/8.jpg)
MODES OF OXYGEN DELIVERY…
HIGH FLOW DEVICE
Mask
mask with 5 lit / min O2 can give 40 – 60% O2
require a minimum O2 flow to prevent rebreathing of CO2
Enclosure system
O2 hood - > 7 lit./ min of 100% O2 required initially to wash out CO2
FiO2 can be 0.21 – 1.
O2 given < 4 lit. min. can be managed without humidifier.
![Page 9: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/9.jpg)
WHAT TO EXPECT FROM ADEQUATE OXYGEN THERAPY
A. Clinical Monitoring:
No cyanosis
No apnoea or periodic breathing
Stable heart rate
B. Non Invasive Monitoring:
Pulse Oximetry
Alarm set 85 – 96% SpO2
Target range 88 – 95% SpO2 Except PPHN
SpO2 >97%
Unable to detect hyperoxia reliably
Plenty of other limitation
![Page 10: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/10.jpg)
WHAT TO EXPECT FROM ADEQUATE OXYGEN THERAPY..
Trans centaneous O2 monitoring
Not accurate in term babies with thick skin
Not used in prematures < 27 wks.
Heat related problems – skin heated to 44oc
C. Invasive monitoring
ABG
Gold standard
8 – 12 hourly – may be required
PaO2 – 50 – 80 mm Hg.
PaO2 – 100 – 120 mm Hg acceptable in PPHN
![Page 11: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/11.jpg)
NON RESPONDERS TO OXYGEN THERAPY
CCHD - COMMONEST LARGE INTRAPULMONARY SHUNT - UNCOMMONMETHAEMOGLOBINAEMIA - RARE
HYPEROXIA TEST
FiO2 0.21 FiO2 1.0 x 10 min
NORMAL 70 (95) >200(100)
CCHD <40 (<75) <70(<85)
PULMONARY 50 (85) >150(100)
![Page 12: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/12.jpg)
MARKERS OF O2 MONITORING
PiO2 = (760 – 47) x 0.21 = 150 mmHg.
FiO2 = 0.21
PAO2 = 100 mmHg
PaO2 = 90 mmHg
SaO2 – O2 saturation derived from arterialised cap. Blood.
SpO2 – O2 saturation by puls. ox
THUMB RULE: FiO2 x 5 = PaO2
![Page 13: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/13.jpg)
![Page 14: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/14.jpg)
UNWANTED EFFECTS OF O2 THERAPY
IMMEDIATE – Some neonate on hypoxic drive going to apnoea.
LATE - ROP – Persistent PaO2 - main contributary factor
CLD
Free radical damage due to O2 therapy.
HIE
HOME O2 DEPENDANCE AND REHOSPITALISATION
NOSOCOMIAL INFECTION
![Page 15: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/15.jpg)
EFFECTS OF NOT ENOUGH OXYGEN
Pulm Vasc. Resistance
Airway Resistance
Risk of SIDS in Infant with CLD
? Limitation in Growth
? Sleep Disorder
![Page 16: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/16.jpg)
O2 – HOW COSTLY IT IS ?
COMMONLY USED – SIZE F CYL. – CAP – 1320 lit.
Refilling cost – Rs. 140.00
5 lit./ min. = 300 lit./ hr. = 4.5 hr. / CYL. = 6 CYL./day = Rs. 800.00 (approx) , without making any profit
PIPED O2 – CYL. USED – CAP – 7100 – 7500 lit.
Refilling cost – Rs. 220.00
Institutions charge – Rs. 400 – 800/day, irrespective
of usage/ day. !
![Page 17: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/17.jpg)
KEY POINTS New born Resus
If O2 not available – Room Air may be enough in 90% cases.
To save life – Do not think of ROP, Short term PaO2 acceptable.
Beyond EMERGENCY period
Strict monitoring of PaO2 necessary.
To Detect ROP Eye exam from 4-6 weeks & 2–4 weekly in<32 wk. < 1250 gm.
Max O2 flow through nasal catheter - do not exceed 3 lit./ min.
O2 hood – initial flow of 7 lit./ min. required.
![Page 18: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/18.jpg)
KEY POINTS….
Keep PaO2 50 – 80 mm. Hg. , SpO2 88 - 95 %
O2 is a DRUG only should be used Documented hypoxia Resp. Distress Cynosis
When prescribing O2 – specify - Dose Device Duration Monitoring
Take care of devices judiciously to prevent – NOS. INFECTION
![Page 19: Presented By : Dr. SUBHASIS ROY, CONSULTANT, SISU SANJIBAN HOSPITAL, SALT LAKE, KOLKATA.](https://reader036.fdocuments.us/reader036/viewer/2022062421/56649d085503460f949d976d/html5/thumbnails/19.jpg)