Breathing in the NICU
Oxygen Therapy
Description/Purpose
Babies with breathing problems are usually admitted to the NICU. Most times, these breathing problems will require oxygen therapy. Normal air that we breathe is 21% oxygen. When oxygen is given to babies, it is measured in percentages, from 21% up to 100%. There are several different ways to administer oxygen to babies. The first is an oxygen hood (halo). This is used for babies who can breathe on their own but still need extra oxygen. A hood is a plastic dome or box with warmed and humidified oxygen inside. The baby's head is placed under the hood. Oxygen tents are the same set up as hoods, except that they are made of a soft, flexible plastic.
Babies with breathing problems are usually admitted to the NICU. Most times, these breathing problems will require oxygen therapy. Normal air that we breathe is 21% oxygen. When oxygen is given to babies, it is measured in percentages, from 21% up to 100%. There are several different ways to administer oxygen to babies. The first is an oxygen hood (halo). This is used for babies who can breathe on their own but still need extra oxygen. A hood is a plastic dome or box with warmed and humidified oxygen inside. The baby's head is placed under the hood. Oxygen tents are the same set up as hoods, except that they are made of a soft, flexible plastic.
Another way to give oxygen is via nasal cannula (NC). This is made of soft, thin, plastic tubing through which oxygen flows. There are soft prongs that fit into the baby's nose so they can breathe the oxygen. This type of oxygen therapy is usually reserved for babies who are going to need oxygen for some period of time. Some infants will even go home on oxygen with a nasal cannula.
Side Effects and Risks
Prolonged oxygen therapy can be related to retinopathy of prematurity (ROP). This is why oxygen is weaned (decreased) as soon as possible. Sometimes, infants under hoods or tents can get chilled if the temperature of the humidified oxygen is not warm enough. Infants on nasal cannula oxygen can get dry or irritated noses from the cannula prongs.
Prolonged oxygen therapy can be related to retinopathy of prematurity (ROP). This is why oxygen is weaned (decreased) as soon as possible. Sometimes, infants under hoods or tents can get chilled if the temperature of the humidified oxygen is not warm enough. Infants on nasal cannula oxygen can get dry or irritated noses from the cannula prongs.
Continuous Positive Airway Pressure (CPAP)
Description/Purpose
Many babies with respiratory conditions require extra oxygen. Some require a ventilator because they cannot breathe well enough on their own. There are also babies that breathe well enough to not need the ventilator, but need a combination of extra oxygen and pressure to help keep their lungs well inflated. CPAP can provide this last group with what they need. To deliver CPAP a tube (or tubes) is placed in the nose and air or extra oxygen is delivered through this tube to the back of the nose. This flow of air produces pressure that goes into the lungs to keep the lungs better inflated. Since the pressure from the CPAP is delivered to the back of the nose it is also called NPCPAP. NPCPAP might be used in conditions such as, Respiratory Distress Syndrome (RDS) when the baby needs more than extra oxygen, to try and prevent the need for a ventilator. Some babies, after they are taken off the ventilator, might be given NPCPAP to keep their lungs inflated. Also NPCPAP might be used on babies who have apnea such as Apnea of Prematurity to decrease the frequency or severity of the apnea. The main benefit of NPCPAP is the ability of delivering both extra oxygen and pressure without the need for the more invasive endotracheal tube and ventilator.
Side Effects and Risks
The main risks of this therapy are nasal irritation (from the tube) and abdominal distention (from pressure in the back of the nose that goes into the stomach instead of the lung). However, just like with the ventilator, babies on NPCPAP might be at risk for pneumothorax.
Many babies with respiratory conditions require extra oxygen. Some require a ventilator because they cannot breathe well enough on their own. There are also babies that breathe well enough to not need the ventilator, but need a combination of extra oxygen and pressure to help keep their lungs well inflated. CPAP can provide this last group with what they need. To deliver CPAP a tube (or tubes) is placed in the nose and air or extra oxygen is delivered through this tube to the back of the nose. This flow of air produces pressure that goes into the lungs to keep the lungs better inflated. Since the pressure from the CPAP is delivered to the back of the nose it is also called NPCPAP. NPCPAP might be used in conditions such as, Respiratory Distress Syndrome (RDS) when the baby needs more than extra oxygen, to try and prevent the need for a ventilator. Some babies, after they are taken off the ventilator, might be given NPCPAP to keep their lungs inflated. Also NPCPAP might be used on babies who have apnea such as Apnea of Prematurity to decrease the frequency or severity of the apnea. The main benefit of NPCPAP is the ability of delivering both extra oxygen and pressure without the need for the more invasive endotracheal tube and ventilator.
Side Effects and Risks
The main risks of this therapy are nasal irritation (from the tube) and abdominal distention (from pressure in the back of the nose that goes into the stomach instead of the lung). However, just like with the ventilator, babies on NPCPAP might be at risk for pneumothorax.
Mechanical Ventilator
Description / Purpose
Babies who are too small or sick to breathe on their own might be intubated with an endotracheal tube and placed on a conventional mechanical ventilator. Another word for ventilator is respirator. The ventilator delivers oxygen to the baby with each breath. It also gives pressure at regular, timed intervals to act as breaths for the baby. Another setting on the ventilator is the constant pressure to keep the lungs open. These settings on the ventilator are increased or decreased based on blood gases. Sometimes the support of a conventional ventilator is not enough for some babies. These babies might need to be placed on a high-frequency ventilator.
Babies who are too small or sick to breathe on their own might be intubated with an endotracheal tube and placed on a conventional mechanical ventilator. Another word for ventilator is respirator. The ventilator delivers oxygen to the baby with each breath. It also gives pressure at regular, timed intervals to act as breaths for the baby. Another setting on the ventilator is the constant pressure to keep the lungs open. These settings on the ventilator are increased or decreased based on blood gases. Sometimes the support of a conventional ventilator is not enough for some babies. These babies might need to be placed on a high-frequency ventilator.
Side Effects and Risks
One of the risks to babies on ventilators is a collapsed lung, or pneumothorax. When a lung collapses, the air around it inside the chest needs to be removed in order for the lung to expand. This is done with a chest tube. Babies who are very premature when they are born might need the support of a ventilator for some time. The longer the babies require this support, the higher risk they have for scarring /damage in the developing lungs, called bronchopulmonary dysplasia.
One of the risks to babies on ventilators is a collapsed lung, or pneumothorax. When a lung collapses, the air around it inside the chest needs to be removed in order for the lung to expand. This is done with a chest tube. Babies who are very premature when they are born might need the support of a ventilator for some time. The longer the babies require this support, the higher risk they have for scarring /damage in the developing lungs, called bronchopulmonary dysplasia.
High-Frequency Ventilator (HFV)
Description / Purpose
A high-frequency ventilator is a special ventilator that uses very high rates (often 480 to 840 breaths/minute) and very small opening pressures for each breath. These ventilators are especially useful for very tiny babies or babies with air leak.
Side Effects and Risks
Same as above.
A high-frequency ventilator is a special ventilator that uses very high rates (often 480 to 840 breaths/minute) and very small opening pressures for each breath. These ventilators are especially useful for very tiny babies or babies with air leak.
Side Effects and Risks
Same as above.
Extra-Corporeal Membrane Oxygenation (ECMO)
Description / Purpose
The use of ECMO peaked in 1992 when over 1,500 infants in the United States were treated. Due to many improvements in care, currently fewer than 500 infants each year require treatment with ECMO. The most common conditions resulting in the need for ECMO are:
The use of ECMO peaked in 1992 when over 1,500 infants in the United States were treated. Due to many improvements in care, currently fewer than 500 infants each year require treatment with ECMO. The most common conditions resulting in the need for ECMO are:
- Congenital Diaphragmatic Hernia (CDH)
- Meconium Aspiration Syndrome (MAS)
- Severe Pulmonary Hypertension
- Cardiac Malformations
- Severe Air Leak problems
The purpose of ECMO is to provide oxygen to the body when the lungs and/or heart are too sick to do the job. ECMO allows us to "rest" the lung and/or heart. Recovery of the lung and/or heart function usually occurs in 3–7 days, but might require 2–4 weeks
Side Effects and Risks
ECMO is the highest risk therapy used in the NICU. Due to this risk there are certain conditions that might prevent the use of ECMO.
Side Effects and Risks
ECMO is the highest risk therapy used in the NICU. Due to this risk there are certain conditions that might prevent the use of ECMO.
- Significant bleeding that has occurred in the brain (intracranial hemorrhage)
- Prematurity with estimated gestation less than 34 weeks
- Congenital malformations that are known to produce death, regardless of support
- Severe pulmonary disease that has persisted for more than 14 days
- Severe Air Leak problems
Several important risks that can occur with ECMO include:
- Rupture of the ECMO circuit tubing
- Formation of blood clots (thrombosis/clots) in the tubing and the baby
- Due to the use of "blood thinners", bleeding can occur in any part of the body
- ECMO requires the use of many blood transfusions; reactions and risks are possible
- Infection is always a risk factor with ECMO
- Death can occur due to the underlying lung/heart problems or from complications of ECMO; infants who require treatment with ECMO are at risk for long-term lung, neurologic, and developmental problems
Tracheostomy
A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. This tube is called a tracheostomy tube or trach tube. General anesthesia is used. The neck is cleaned and draped. Surgical cuts are made to expose the tough cartilage rings that make up the outer wall of the trachea. The surgeon then creates an opening into the trachea and inserts a tracheostomy tube.
Why the Procedure Is Performed:
A tracheostomy may be done if you have:
- A large object blocking the airway
- An inherited abnormality of the larynx or trachea
- Breathed in harmful material such as smoke, steam, or other toxic gases
- Cancer of the neck, which can affect breathing
- Breathed in harmful material such as smoke or steam
- Paralysis of the muscles that affect swallowing
- Severe neck or mouth injuries
- When you can't breathe on your own
Risks:
The risks for any anesthesia are:
- Problems breathing
- Reactions to medications
The risks for any surgery are:
- Bleeding
- Infection
- Erosion of the trachea (rare)
- Nerve damage
- Scar tissue in the trachea
After the Procedure:
If the tracheostomy is temporary, the tube will eventually be removed. Healing will occur quickly, leaving a minimal scar.
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