SMA1 baby intubated!

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curiousgeorge
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SMA1 baby intubated!

Postby curiousgeorge » Thu Mar 17, 2016 12:19 pm

My 4 month old baby with SMA1 is intubated. So if I understand correctly, the vent settings on the CMV mode should be pretty much the same as what his NVS support settings will be after extubation, correct? Including keeping the rate at or above 30, without making him trigger breaths?

(Asked by a parent)

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bachjr
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Re: SMA1 baby intubated!

Postby bachjr » Thu Mar 17, 2016 12:21 pm

Yes, if he needs to trigger too many breaths over the set rate, then the delivered volumes are not high enough. If using biPAP modes (not ideal but all that local physicians and therapists are usually familiar with) then the IPAP should be 16-20 over the EPAP and the EPAP left minimum, usually 4 cm H2O.

Better than biPAP is to use an active vent circuit and give on 16-20 cm H2O when inhaling and not stop the exhalation using EPAP at all.

When asleep he should be fully in synchrony with the machine, that is, every breath assisted by it. Frankly, when awake he shouldn't need the machine at all if MIE is used properly. A cry vital capacity of 50 ml or greater means that he does NOT need the machine during the daytime.

JB
John R. Bach MD
Medical Director, VentilaMed BreatheNVS
Medical Director, Center for Ventilator Management Alternatives
Professor of Physical Medicine and Rehabilitation, Professor of Neurology, Rutgers New Jersey Medical School


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