There are many different modalities of ventilators and respiratory devices in the NICU setting. The risks and benefits should be discussed with your neonatologist, as well as the indication for use on your baby. NICU nurses HEAVILY RELY on our respiratory therapists, since they are the ones who literally “eat, sleep, and breathe” all things related to preemie lungs! Here is my short and hopefully helpful description of the various types of NICU respiratory support:
HFOV (High Frequency Oscillator Ventilator) — Provides smaller, faster, but shorter bursts of breaths which may be less damaging to the preemie’s fragile lungs. This type of ventilator helps to reduce the chronic respiratory problems experienced by babies born prematurely by improving carbon dioxide elimination.
Various Mechanical Ventilators (Conventional, Drager, etc.) — A machine that helps the baby breathe (via breathing for the baby) when the baby is unable to breathe on his/her own.
HFJV (High Frequency Jet Ventilator, “Jet”) — High-frequency ventilators are often used for very small, very sick, extremely premature babies. They breathe much faster than conventional ventilators.
CPAP (Continuous Positive Airway Pressure) — A mode of ventilator assistance in which positive pressure is delivered to the airway throughout the respiratory cycle. Constant air pressure is transmitted down into the baby’s lungs, helping them to stay inflated (distended) and eliminating alveolar collapse.
SiPAP — A type of non-invasive ventilatory support used in preemies. It provides bi-level nasal CPAP for the spontaneously breathing neonate through the delivery of sighs above a baseline CPAP pressure. These sighs may be timed, at a rate specified by clinicians, or “triggered” by the baby’s own inspiratory efforts. This mode is also used when extubating patients and helps to maintain functional residual capacity, reduce work of breathing, and stimulate the respiratory center.
HFNC (High Flow Nasal Cannula) — This is a small plastic tube that goes into the baby’s nose and is humidified with increased oxygen/air potential. The air-oxygen flow (via blender) ranges from 1-6 L/minute. Minimal oxygen support is provided with high pressure.
RAM Cannula — A “newer” oxygen delivery device that can be used as an alternative approach to delivering positive pressure. By providing a continuous distending pressure and intermittent breaths, this mode improves tidal volumes, reduces work of breathing, improves oxygenation, and increases carbon dioxide elimination. Due to the increased diameter of the inner nasal prongs, a decrease in airflow resistance is allowed when compared to a traditional nasal cannula.
iNO (Inhaled Nitric Oxide) — Improves gas exchange in infants with chronic respiratory failure (persistent pulmonary hypertension of the newborn “PPHN”) through enhanced ventilation-perfusion matching and/or a reversal or extrapulmonary shunting.
Oxygen blenders allow the fraction of inspired O2 concentration to be adjusted between 21% and 100%
NICU RTs & RNs… Am I missing anything from the list? What are your thoughts, comments, suggestions, questions, etc.? Isn’t it so incredible how the loud, scary, bulky, ancient ventilators that existed when dinosaurs roamed the earth are the ones that are the most gentle, successful, and effective on the preemie’s tiny, fragile lungs?