BASIC RESPIRATORY

MANAGEMENT
Joestiantho Laurenz Kilmanun
Assessing and monitoring respiratory
status
Physical
Examination Nasal flaring
Grunting
Retractions
Tachypnea
Cyanosis
Abnormal breath sounds
Assessing and monitoring respiratory
status
Blood Arterial blood gas studies
Gases
Normal arterial blood gas values

Calculated arterial blood gas values

Venous blood gases

Capilary blood gases

Assessing and monitoring respiratory
status Non Invasive
gas monitoring

• Limitation : Include poor correlation of

Pulse Sao2 to Pao2 at upper and lower Pao2
values.
Oximetry • Adventage : Include minimal damage to
(The pulse oximeter
the skin and no required manual
measures the relative calibration
absorption of light by • Disaventage : Include the tendency of
saturated and unsaturated patient movement and excessive external
hemoglobin, which
absorbs light at different lighting to interfere with readings and the
frequencies) lack of correction for abnormal
hemoglobin (eg, methemoglobin)
Assessing and monitoring respiratory
status Non Invasive
gas monitoring

• Limitation : Include the need for daily

recalibration, relocation to different skin
Transcutaneus sites every 4–6 hours, and irritation or injury
oxygen (tcPo2) to a premature infant’s skin secondary
to adhesive rings and thermal burns. Poor skin
(Measures the partial perfusion caused by shock, acidosis,
pressure of hypoxia, hypothermia, edema, or anemia
oxygen from the skin may prevent accurate measurements.
surface by an
electrochemical sensor) • Adventage : tcPo2 is noninvasive and may
provide indication of excessively
high Pao2 (>100 mm Hg).
Assessing and monitoring respiratory
status Non Invasive
gas monitoring

• Usually accomplished
Transcutaneous simultaneously by a
carbon dioxide
monitoring single lead enclosed
(tcPco2) with a tcPo2
electrode
Assessing and monitoring respiratory
status Non Invasive
gas monitoring
End-tidal Co
2 monitoring • Limitation :An adapter to the endotracheal
tube is required, which may significantly
(ETco2 or increase the dead space of the patient’s
circuit. Accuracy is limited when the
Petco2) respiratory rate is >60 breaths/min or if the
humidity of inspired air is excessive. Current
devices are of limited use for premature
Expired breath analysis by infants.
infrared
spectroscopy for Co2
content gives close • Adventage : IIt is a noninvasive technique that
correlation to Paco2. This may correlate well with arterial
technique is Paco2.
increasingly available for
neonates.
Types of respiratory support
 Infants with respiratory distress may need only
supplemental oxygen, whereas those with
respiratory failure and apnea require mechanical
ventilatory support.
Oxygen supplementation without
ventilation
Oxygen hoods
• Provide an enclosure for blended air-oxygen supply, humidification,
and continuous oxygen concentration monitoring.
• Hoods are easy to use and provide access to and visibility of the
infant

Mask oxygen
• Usually not as well tolerated or controlled as nasal cannula
oxygen delivery

Nasal cannulas
• Well suited for infants needing low concentrations of oxygen
• Delivery can be controlled by flow meters delivering as little as
0.025 L/min. Flow rates of >1 L/min impart distending airway
pressure.
Continuous positive airway pressure
(CPAP)
 A nasal mask, nasal CPAP Continuous-
prongs, or an devices flow CPAP
endotracheal tube can devices
be used to apply
CPAP to improve Pao2
by stabilizing the Variable
airway and allowing flow CPAP
alveolar recruitment.
Continuous-flow CPAP devices

Bubble CPAP Ventilator-derived CPAP

• A warmed humidified gas is

continuously provided through
the inspiratory limb using a blender
• Infant
and a flow meter. ventilators
are used to
• CPAP is created provide a
by submersing the expiratory limb of
the respiratory tubing into a water continuous
chamber to the depth of the desired
cm H2O CPAP level.
flow of a
blended gas.
• A sufficient flow of
gas through the system creates
continuous bubbling in the water
chamber.
Variable flow CPAP
 These devices (such as Infant
Flow SiPAP System) use a
dedicated driver and generator
with unique fluidic mechanics that
adjust and redirect gas flow
throughout the respiratory cycle.
 Requires specially designed
nasal prongs.
CPAP modes of delivery
Nasal mask CPAP
• Requires the proper size mask and a good seal on the face
to be effective.
• Although more cumbersome than nasal prongs, a mask reduces
risk of injury to the nasal septum

Nasal CPAP (nCPAP)

• Nasal prongs are the most commonly applied means of delivering
CPAP and are used for respiratory assistance in an infant with mild
RDS.
Nasopharyngeal CPAP.
• An alternative to nasal prongs. An endotracheal tube
or long binasal prongs are passed nasally and advanced to the
nasopharynx.

Endotracheal tube CPAP

• Rarely used or indicated in neonates
Reference
 Gomella TL, Cunningham MD, Eyal FG.
Neonatology- Management, procedures, on-call
problems, diseases, and drugs. McGraw-Hill
Education; United States. 2013
THANK YOU
Joestiantho L. Kilmanun