chronic cpap

BittyBabyGrower, MSN, RN · Jan 11, 2009

That's a tough one...he isn't requiring mechanical ventilation, right? Is it an airway issue, does he tolerate high flow cannula? Did they do a course of steroids? We usually don't go to a pressure of 8, +6 is about our limit, then they buy a tube. Traching comes with a whole other issue of problems, so many docs are reluctant to do it.

mgturtle · Jan 11, 2009

You need to find out the source of the problem. It could be neuro, respiratory, sedation, etc. Have MRI's, bronchs, and other tests been done? I had a kid on CPAP for longer than two months. We felt like we knew what the underlying problem was. When we were able to correct that problem the kid went home on a NC. I hope that helps.

dawngloves, BSN, RN · Jan 11, 2009

Usually when they have reached term we try and get them off. If that fails, after a month, we send them out for a trach.

elizabells, BSN, RN · Jan 12, 2009

For. Ev. Er.

Or until their insurance tells us to quit screwing around and send them to LTC, in which case we try to get them to NC. Trachs only for airway issues or long term (like, MONTHS) intubation.

sweet0176 · Jan 12, 2009

Well this kid was only intubated/oscillated for a bit, but was weaned to cpap. But like I said this kid has been on CPAP for 2 months and has failed numerious times to get the Peep decreased on the cpap. The kids lungs are horrible, the air entry sucks, and spends most of the time in 35-40% o2. As soon as you take the cpap out the kiddie immediately desats and becomes air hungry.

sararn1 · Jan 14, 2009

We have recently had a similar problem. I did some research and found that these type babies, (I am assuming he was a VLBW preemie) are sometimes left on CPAP too long before the weaning process begins. There are few if any weaning guidelines out there and I have looked! So I took what we hope to be the ideal time to start weaning and I have written our own NCPAP guidelines and I restate these are only guidelines because we all know babies never do what you expect. (Also there are no real studies to look at so my guidelines are written just from our own exerience.) We never use a nasal cannula unless the baby is cardiac or the rare baby who was on the vent and in O2 forever who doesn't require PEEP but requires O2. Our first goal is to wean off oxygen so that is our first priority. ( We never use a PEEP >6 because at this point we would oscillate the baby for a few days and try him off later. ) When these babies reach 29+ weeks and are in room air for 72 hours we start weaning but not the PEEP which in our unit 99% of the time 5. We wean by time off/time on. Term and near term babies who are here for TTN or mild RDS are weaned differently. We have not had a baby who had to be trached in at least 10 years.

sweet0176 · Jan 14, 2009

to sararn1

this baby was not that preterm- just born with really crappy lungs (was a 30weeker twin)- was oscillated and vented briefly. this baby is now full term, and like i said has failed many times trying to get the peep down to a 6, and is still in a significant amount of o2. we are trying to get the kiddie weaned from the cpap slowly and surely, but it just isn't happening

sararn1 · Jan 15, 2009

What type of cpap device do you use? I know most places don't use decadron anymore but when you get to the point of traching a baby you sometimes take extreme measures. Have you considered a short course to help him wean?

Sweeper933 · Jan 16, 2009

We will sometimes do a "Dex burst" of 3 days to help chronics make that final wean off the vent / CPAP... the docs always discuss it in length wit the parents before hand though - to make sure they are fully aware of all of the ugly side effects of Dexamethasone. Too bad there are such bad side effects... it works so well!

Back to your baby stuck on CPAP... is he on all the support meds? (ie diuretics, theo...albuteral / pulmicort???)

UTVOL3 · Jan 16, 2009

I have seen kiddos on cpap for 2 mos, even 3. That is quite a bit of pressure though. Our pulmonologist really liked to bronch and then just wait it out, assuming he found nothing on the bronch.

lvnurs9 · Jan 18, 2009

So this kid is 40 weeks now? I rarely see a CPAP of 8. I would think that if steroids haven't worked, that the MDs need to create a timeline. I mean, you can't keep a kid in the hospital forever just because you don't want to do anything about their problems... It's cruel and incredibly developmentally inappropriate!

I am having an issue with this as well....