[night_owl_504]

Originally Posted by RainDreamer

If you worked in the neonatal ICU and jumped everytime a chronic RDS kiddo hit 81, you'd be doing a whole lot of jumpin'!

i didnt know we was talkin neonates here...

[RainDreamer]

Originally Posted by night_owl_504

i didnt know we was talkin neonates here...

We weren't. But you said "any unit"

[ghillbert]

I would want more information - and before instituting any treatment, I would keep in mind it's a neuro patient and want to know what their problem/injury is. For example, you would not necessarily want to turn a neuro patient if they have associated cervical injuries etc. Are they already ventilated? Can you run a blood gas and check what their pO2 is before you bag etc.? Always assess before treating.

BP - it's super important in neuro patients to keep an adequate cerebral perfusion pressure. So if you have a hypotensive patient, you need to add pressors to keep the BP high enough to overcome any raised ICP and maintain cerebral blood flow.

Just keep in mind whatever you're doing, that it's a neuro pt.

Good luck!

[vballmanrn]

I would be careful how you answer this question. If the pt has increased ICP or a dissection you don't want them to cough. You want to carefully assess them and find out the cause of the hypoxia. You definitely want to get the O2 back on a neuro pt. If they have decreased O2 and have a head injury their ICP will rise until the CO2 is decreased.

[MadJackie]

Firstly LOOK and ASSESS your patient.

If your patient is sat there, talking to you or happily reading a book - don't panic!
Check all your settings/equipment etc.

If your patient is laid there, going blue, then SHOUT for help!

[joeyzstj]

Originally Posted by RainDreamer

If you worked in the neonatal ICU and jumped everytime a chronic RDS kiddo hit 81, you'd be doing a whole lot of jumpin'!

Just becasue someone doest jump at a problem doesnt make the problem not exist. 81% sustained for anyone is too low. I personally am very interested to hear your rationale behind why an Sp02 of 81@ on a Neonate, let alone an adult isnt a concern to you? Ive worked in critical care, Respiratory Therapy and with neonates and this is the first time Ive ever heard this one?

[Sweden]

Originally Posted by joeyzstj

Just becasue someone doest jump at a problem doesnt make the problem not exist. 81% sustained for anyone is too low. I personally am very interested to hear your rationale behind why an Sp02 of 81@ on a Neonate, let alone an adult isnt a concern to you? Ive worked in critical care, Respiratory Therapy and with neonates and this is the first time Ive ever heard this one?

Neonates are an entirely different patient group and the same rules don´t apply....

Some of my patients make regular desats down to 10 (sats) and we watch and just stand back and wait for them to recover again. Doing somehing, anything, even just opening the incubator doors only means that the baby will take longer to recover.

To stand back even if the patient is doing poorly is one of the hardest lessons one needs to learn doing neonate care. It doesn´t mean that I don´t care about it, I still do an assesment and try to decide the moment when this isn´t ok anymore.

Some babies go from 97 to 15 to 96 in just a few minutes, disturbing them just means they will stay longer in the lower range.

Sorry, didn´t mean to hijack the thread..

Anna

[joeyzstj]

Originally Posted by Sweden

Neonates are an entirely different patient group and the same rules don´t apply....

Some of my patients make regular desats down to 10 (sats) and we watch and just stand back and wait for them to recover again. Doing somehing, anything, even just opening the incubator doors only means that the baby will take longer to recover.

To stand back even if the patient is doing poorly is one of the hardest lessons one needs to learn doing neonate care. It doesn´t mean that I don´t care about it, I still do an assesment and try to decide the moment when this isn´t ok anymore.

Some babies go from 97 to 15 to 96 in just a few minutes, disturbing them just means they will stay longer in the lower range.

Sorry, didn´t mean to hijack the thread..

Anna

I would be very interested in reading any literature or studies that you have that suggest a sustained Sp02 of 80% for a neonate is an acceptable practice.

[RainDreamer]

Originally Posted by joeyzstj

I would be very interested in reading any literature or studies that you have that suggest a sustained Sp02 of 80% for a neonate is an acceptable practice.

There was no mention of "sustaining" sats of 80%. It's not uncommon for chronic babies with BPD to drop their sats down to 80. Typically they go right back up with no intervention.

As far as sustaining sats at 80% .... that's actually where we want our cardiac babies to be (i.e. doctors will write orders to keep sats 75-90).

It's all about knowing your patient population.

[joeyzstj]

Originally Posted by RainDreamer

There was no mention of "sustaining" sats of 80%. It's not uncommon for chronic babies with BPD to drop their sats down to 80. Typically they go right back up with no intervention.

As far as sustaining sats at 80% .... that's actually where we want our cardiac babies to be (i.e. doctors will write orders to keep sats 75-90).

It's all about knowing your patient population.

You yourself just mentioned in the above post that you keeps sats 75-90%. If you "keep" something in that range that says to me its sustained. I am asked to do things everyday by physicians.........some are very intelligent and some are completely insane. My point is, show me some literature, studies, books,...........essentially anything that states that allowing a neonate to maintain sats of 80% is an acceptable practice (Evidence based practice). I understand that neonates have frequent desaturations and understand very well the processes behind BPD, however I am (In all seriousness) very interested to read any solid research or studies that show this is acceptable, not someone just telling me "the doctor tells me to do it so I do". How about some physiology behind why this is acceptable? The orginal question in the post was about a Neruo ICU patient and its developed into a thread thats made me curious about this practice in your NICU. In all sincerity, I am very interested to learn about the logic behind this.