Do nurses help preterm babies to exhale?

Specialties NICU

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Hi I am currently doing a design project. the problem given by the engineering lecturer is preterm babies have respiration difficulties. the machine that helps the babies to breathe, just help them to inhale but not exhale. there are nurses in the nursery who massage the babies stomach to exhale. design a something that can detect the exhalation of the babies.

I read up information on preterm babies. but i couldn't find any information on babies that exhale by the help of nurse. I only found CPAP and other mechanical ventilators.

I would like to know whether the situation given is true? which levels of NICU babies recieve this treatment?

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Specializes in Trauma Surgical ICU.

I will give you a bump, because I have never heard of this. It is my understanding that exhaling is a natural mechanism. I really don't know if a pre-term baby has issues with exhaling as I don't work peds or NICU.

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Specializes in Public Health, Women's Health.
I will give you a bump, because I have never heard of this. It is my understanding that exhaling is a natural mechanism. I really don't know if a pre-term baby has issues with exhaling as I don't work peds or NICU.

That's what I was thinking also. I'm a new grad so I don't know that much, hopefully a NICU nurse will know but I thought we exhaled because of the difference in the pressure of the outside the lungs from within the lungs? I know that some machines don't have sensors to sense if the neonate is exhaling so perhaps that would be the need of something there to counteract the continuous air pressure? Just my guess though! Hope someone else can help, I'd like to know what they say.

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Specializes in NICU, Infection Control.

My first reaction is "WHAT???" I'm having visions of nurses running around the unit, massaging babies' tummies, hopefully washing their hands in between pts.

The pathophysiology of Respiratory Distress Syndrome is that the alveoli lack surfactant which is necessary keep them open--the alveoli collapse to prenatal status; this requires the baby to re-inflate the alveoli each time s/he breathes.

You know how hard it is to blow up a balloon the first time, then it's easier on subsequent times. When things are working properly, the 1st breath takes a lot of effort, then residual air remains in the air sacs, making it easier on subsequent breaths.

Most respiratory assistance is aimed @ firstly providing surfactant, and then maintaining air pressure in the lungs so that the baby doesn't have to work so hard to breathe. It's called Continuous Positive Airway Pressure (CPAP). (other terms exist). This makes it easier to inhale, but they [babies] don't need any help to exhale. Sometimes CPAP is combined w/an assisted respiration from the ventilator, a change in the pressures that imitate a more natural respiratory cycle.

Sometimes, babies swallow more air w/this therapy due to the extra air/O2 in their airways; that can be controlled in a number of ways.

Hopefully, that helps and is in keeping w/current practice. Any one else want to chime in?

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Specializes in NICU, Infection Control.

I think your lecturer needs to have a conversation w/a Respiratory Therapist that specializes in neonatal care. jmo

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I agree with prmenrs. The issue is usually avoiding alveolar collapse at the end of a breath. There is at least one mode of ventilation -high frequency oscillatory ventilation - that utilizes both active inspiration and expiration. (Active exhalation is necessary in that mode because we're trying to deliver hundreds of tiny pressure oscillations to the baby each minute.)

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No, nurses don't help them exhale. It's a natural process/gravity. It's the same thing with CPR. Do you help the patient exhale then? The answer is no. Same thing with preemies. ;)

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Specializes in med-tele/ER.
No, nurses don't help them exhale. It's a natural process/gravity. It's the same thing with CPR. Do you help the patient exhale then? The answer is no. Same thing with preemies. ;)

Breathing is not controlled by gravity. Breathing is all controlled by Boyle's gas law P1V1 = P2V2.

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Thanks for your explanation...me and my classmates do react the same way like u when we get this situation. I think my lecturer just want us to design the exhalation detector and simply gives us some situation. Now i know shouldn't crack my head to figure on the situation

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My apologies, Matt. My point is that a person is not physically doing anything to get a baby or adult to exhale. It just happens. Exhaling with a mechanical vent is the same process as when a person performs CPR. You don't force a person to exhale when doing CPR, you aren't going to force them to exhale with mechanical ventilation. But, thanks for your physics/chemistry explanation. ;)

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Specializes in NICU, Infection Control.

"I think my lecturer just want us to design the exhalation detector...."

Actually, there is such a device that is used when a pt (adult or peds) has an endotracheal tube placed to assist breathing; it detects CO2 on exhalation and verifies that the ETtube is in the trachea, not the esophagus.

Here's the link: Covidien EASYCAP II Co2 Detector @ SummitSurgicalTech.com Covidien EASYCAP II Co2 Detector [EASYCAP II] - $347.00 : @ Summit Surgical Technologies., Shop and save on Medical Equipment, Refrigerators, Freezers and more.

I hope that helps!

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My first reaction is "WHAT???" I'm having visions of nurses running around the unit, massaging babies' tummies, hopefully washing their hands in between pts.

The pathophysiology of Respiratory Distress Syndrome is that the alveoli lack surfactant which is necessary keep them open--the alveoli collapse to prenatal status; this requires the baby to re-inflate the alveoli each time s/he breathes.

You know how hard it is to blow up a balloon the first time, then it's easier on subsequent times. When things are working properly, the 1st breath takes a lot of effort, then residual air remains in the air sacs, making it easier on subsequent breaths.

Most respiratory assistance is aimed @ firstly providing surfactant, and then maintaining air pressure in the lungs so that the baby doesn't have to work so hard to breathe. It's called Continuous Positive Airway Pressure (CPAP). (other terms exist). This makes it easier to inhale, but they [babies] don't need any help to exhale. Sometimes CPAP is combined w/an assisted respiration from the ventilator, a change in the pressures that imitate a more natural respiratory cycle.

Sometimes, babies swallow more air w/this therapy due to the extra air/O2 in their airways; that can be controlled in a number of ways.

Hopefully, that helps and is in keeping w/current practice. Any one else want to chime in?

Great reply pr! :)

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