O2 administration in RSV babies

Specialties PICU

Published

Hey all,

So I work on a med/surg floor of a Children's Hospital. We get a fair amount of RSV/bronchiolitis/rhino/entero babies. Sometimes I struggle with knowing when to put oxygen on them.

Obviously if baby is desatting and having trouble holding a good sat, you do O2. But what if baby is satting ok - 93-95% - but working hard to breathe?

The other night I had such a kid. 2 months old, satting 93-96%, respirations 50-60s while sleeping, but moderate subcostal retractions and some mild head bobbing, even after suctioning. I spent the whole night debating whether I needed to start her on oxygen. I know once you do start, it sometimes takes a while to wean them off it (our babies like to hang out on 0.06L forever). She just made me so nervous.

What's your take?

heinz57

168 Posts

Time to bring out the HFNC. It is safe enough for med-surg and managed by nurses. You can give enough flow to reduce work of breathing and keep FiO2 given low.

Babies shouldn't have to work that hard to maintain their SpO2. If they tire and RR slows, the SpO2 will plummet and it can quickly become a crash and burn situation.

Zelda, RN

70 Posts

Specializes in Pediatrics.

I assume you mean high-flow nasal cannula. It is still very new at my hospital, at least on medsurg. We just started using it this past March, and I have yet to see it used in practice. Nurses aren't supposed to mess with it - only RT at this point.

RT disagreed with me about how hard baby was working to breathe. This was last night. Today, she was still working hard and began wheezing, so they started breathing treatments and switched her to hypertonic fluids. She looks much better tonight.

Jolie, BSN

6,375 Posts

Specializes in Maternal - Child Health.

I encourage you to consider that providing supplemental oxygen in and of itself will not reduce the baby's work of breathing.

Grunting, retracting and nasal flaring are all indicators that an infant is working too hard to move air in and out of the lungs. While the oxygen saturation may temporarily hold in the "OK" range of 93-95%, the baby is likely to decompensate and supplemental oxygen alone won't be sufficient to rescue the baby at that point.

The least invasive means of supporting a baby who is working hard to breathe is prone positioning with the head of bed elevated. Bracing the sternum and ribcage against a firm mattress lessens the work of breathing, and may buy you time to set up a high flow cannula or CPAP at the bedside. It is best to intervene with these measures before the baby is completely exhausted and needs intubation and ventilation.

Specializes in Pediatrics.

Time to look into HiFlow

We put our babies on it all the time. This respiratory season we created protocols to for HFNC.

We look at respiratory rate

Retractions

Lung sounds

And sats

Anything above a score of 4 the nurses can initiate HFNC. The RT still sets it up but they are a standard of protocols established with MD, RN and RTs

I work in the ED

We score them suction score them again

If we start HFNC we run at the highest settings to be able to go to the floor for an hour then we reassess

Always look at the work of breathing and rate of breathing

We can titrate the flow down if there is an improvement and then PO trial.

No improvement we increase the flow and start an IV

We also consider how often you are suctioning, q30, q1hr

With HFNC it is not only the oxygen it is the flow that is keep those airways open making it easier for baby to breathe

You sat # is just one of many things to look at with Bronchiolitic babies

Work of breathing is so important they can and will tire out quickly and you can go from distress to respiratory failure quickly

Plus when they are breathing that fast and hard think about their metabolic status and fluid intake

If they are using up all their energy to breath they need fluids

They need assistance, if you were debating using the oxygen and the RT disagreed did you call the MD?

And you stated you held off the oxygen because they took a long time to wean?

Maybe those babies needed oxygen sooner or HFNC?

GE90

88 Posts

93-96% is not a bad sats, however with a rr of 50-60, ineffective suction, moderate recessions and head bob = the child is working pretty hard

i'll let the team know while trying low flow nc or neblizing hypertonic saline + resuction....but in my limited experience (5months in general paeds with heaps of bron), quite often these type of patients would eventually require HF oxygen...

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