Management of PPHN, pre-ecmo

[ittybabyRN, RN]

Hello!

I was just wondering what other ecmo-utilizing units to do to best manage PPHN before it reaches that point?

We had a kid this past week who was doing pretty well until he "flipped" during line placement. I heard later that day that nurses were requesting versed and the docs didnt want to give it because they are trying less and less to use versed to prevent brain injury from it, we also do not use fentanyl d/t rigid chest syndrome, so basically the options left are morphine, Vec if we really beg and think the kid will benefit. I didn't have the baby so I don't know all the details but he did end up on ECMO though the previous day it seemed he had turned a corner in the right direction.

How do you manage these kids sedation-wise on your units, any other managements you use?

[BittyBabyGrower, MSN, RN]

Wow. If we have a kid flip, they are on a fent and versed gtt faster than we can say order it. If they are teetering we sedate with versed at least. We rarely use vec...those kids start to third space and then you get into a whole new problem. We only paralyze if they are obnoxious on the vent and their gases aren't going anywhere. We will also nitric them. We have only had maybe 3 kids get sent out for echmo, and those kids were bad from the get go.

[ittybabyRN, RN]

Thanks for that info! I am a brand new NICU nurse off orientation in Feb, I work at a large teaching hospital so I get to listen to the arguments that occur between the older nurses and the newer docs regarding certain treatments, the nurse who had this kid yesterday was one of those older nurses who kept trying to get versed drip, I had asked her why we didn't use fentanyl because I know it is widely used in neonates in the CICU but she told me they used to use it but dont anymore....however she preferred it. I think in some things on my unit it can be a constant struggle between what the new literature is suggesting and what the older docs/nurses think is appropriate. I am just wondering if this kiddo had been sedated more if it would have kept him off ecmo. And initially yes he was on nitric as well as conventional vent...did go onto the oscillator a few hours before ecmo

[SteveNNP, MSN, NP]

Dobutamine and/or milrinone.... nitric, maybe some versed. And we wouldn't be mucking around with lines without some sedation onboard.

[ittybabyRN, RN]

Dobutamine and/or milrinone.... nitric, maybe some versed. And we wouldn't be mucking around with lines without some sedation onboard.

Interesting, I've never heard of a PPHN-er on milirinone (we do have the older, pulmonary hypertension kids on it), and we would have dopamine/epi on if hypotension is also an issue (which it was)

[BittyBabyGrower, MSN, RN]

We use Dobut too, then head to Milrinone if the pressure still suck. We rareley use epi

[Ginapixi, BSN, RN]

looks like this might be a good place to raise the question i have: how often does PPHN occur in term babies that are some what compromised respiratory wise only after birth (too much fluid in their lungs - no mec) mild acidosis which quickly responds to O2 via NC and IV fluids??????????