Medical Officer to be present at bedside when HFOV commences. Amplitude needs to be adjusted by observing the baby’s chest until there is an adequate wiggle. If SaO2 poor/does not improve recruitment to be done by senior medical officer.
Conventional ventilator circuit may be used or attach non-disposable HFO circuit
Attach an in-line suction catheter to the circuit
Open suction may be used in circumstances where secretions are causing tube blockage and cannot be removed with in-line suction.
The oxygenation can be increased by:
Increasing MAP to recruit the alveoli-this has the most profound effect on oxygenation
Optimum MAP corresponds to an AP chest film showing 8-9 posterior ribs
For ongoing hypoxia consider
Equipment failure (DOPE test)
Urgent chest x-ray-alter MAP based on over distension or under distension
Section 10 - Neurally Adjusted Ventilatory Assist (NAVA) in Neonates
Neurally Adjusted Ventilatory Assist (NAVA) is a mode of mechanical ventilation intended for use in spontaneously breathing patients. It delivers ventilation in synchrony with and in proportion to the infant’s efforts. The patient's own electrical diaphragmatic activity (Edi) waveform is used to trigger-on and cycle-off each assisted breath. The pressure delivered depends on the size of the Edi signal, thus providing well synchronized proportional assist ventilation. The Edi waveform is recorded with an “Edi catheter”, a standard-sized naso- or orogastric feeding tube with miniaturized sensors embedded within. When correctly placed at the level of the gastroesophageal junction, the Edi signals are detected from the crural portion of the diaphragm.
This section applies for non-invasive NAVA (NIV-NAVA) only.
Contraindications for using NAVA are:
MRI scanning: Edi catheter must be removed before MRI scanning
Assess correct Edi catheter size for patient and measure length from nose/mouth to ear to xiphisternum (nose- first preference to avoid movement of the catheter)
Wet Edi catheter using sterile water. Pass and secure as you would a nasogastric (NG) or orogastric (OG) tube
Connect ventilator to oxygen and air wall supply
Plug ventilator power cord into blue UPS power point
Insert humidifier base power cord to wall power supply
Ensure expiratory block is in situ as per picture 1. This is sent to pre-rinse for sterilization between patients. There are 2 patient expiratory blocks. The spare block is kept with the other expiratory blocks in the clean utility room, in the cupboard above the bench