Help identifying lung sounds of vent baby

Amanda831 · Jun 9, 2011

I've been a pediatric home care nurse for about five years to kids with trachs and vents. While reading your post, the first thing that caught my attention was the nasal flaring and mild retractions. To me, that signals an increased work of breathing. The resp rates you stated seem awfully high to me. Does this baby have a cuffed or uncuffed trach? Does this baby have use of his upper airway? It almost sounds like he's compensating by breathing thru his upper airway...that to me signals that perhaps the trach is plugged or there needs to be more moisture thru the circuit. Also, some kids that have cuffed trachs will breathe easier and at a slower pace if the cuff is inflated, allowing the vent to do most of the work. I know that wasnt your question but I'd thought it was worth mentioning.

Now for breathe sounds...when you listen to clear lungs, it will sound almost like Darth Vader, if that makes sense, ha.

Rhonchi sounds like a snore and usually signals congestion, in which suctioning would be needed. And you would document which lobes are involved, either upper or lower.

Rales usually indicates fluid in the lungs. It would sound like a clicking or popping noise. You usually wont hear rales unless the child has pneunmonia or something like that.

Some vent kids will have UAC, upper airway congestion, depending if they have use of their upper airway.

Try this website as well...http://www.wilkes.med.ucla.edu/lungintro.htm

mb1949 · Jul 5, 2011

Hi n315,lpn,
I am a pediatric ICU nurse, and I know exactly the kind of baby you're dealing with. Best advice I can tell you, don't worry about the sounds. I'm not telling you not to worry about anything, you sound like you just lack a little experience and maybe some confidence. Let me tell you what exactly a baby like this has gone through.
To give you an idea, because premature babies are born with underdeveloped lungs, and the variety of things that go wrong, like respiratory failure. They mec aspirate, or born to early, or develop an infection. They have acute respiratory failure, their lungs fill up with fluid get edematous and no longer have adequate gas exchange. Maybe a little pulmonary hypertension on top of that to give a little multisystem organ failure and you should of seen this kid when he was 2 or 3 days old on a ventilator, probably either jet ventilator or high frequency occillator, maybe a little nitric therapy and all these lines and tubes in side of him. A UA catheter here, an L cath there. These kids unfortunately sometimes get better but not completely healthy or even normal, and they almost always develop chronic lung disease. So you're probably looking at a very delayed child, probably with multiple medical problems, maybe a little syndromy (PICU nurses make up their own words sometimes). You know chromosomal deletion, maybe a really low one. Probably very delayed or mentally retarded, maybe spastic cerebral palsy. Just an all around train wreck.
CLD can be irreversible, sometimes the babies will grow back viable lung tissue but this isn't the case most of the time because of the repeated exposure to therapies to keep the buggers alive, namely chronic ventilator support and the resulting barotrauma, also the effects that free radicals have destroying lung tissue being on oxygen so long.
So these kids end up with having jacked up lungs in general. The kid sounds like he breathes really hard, thats because he doesnt have as much (if any) viable lung tissue a healthy infant does for gas exchange, and why he needs to be on a ventilator. I once took care of an infant who made it to 13 months of age with only a little bit of his right lower lung left. Well what happened to him was he got pneumonia in that little bit of lung and died within a few hours, just to tell you how fragile these kids are. Can't live without lungs, and putting this kid on ecmo is just crazy stupid.
If he sounds coorifice all the time, his lungs are also producing a lot of mucous which you probably suction all time from this kids trach. If he sounds wheezy his airways are constricted, from mucous or bronchospasming, so he needs bronchodilators constantly.
Don't focus on the lung sounds too much, pay attention to how the kids looks like his overall work of breathing. You should also have a pulse oximeter. Also keep in mind these kids should be on palliative care and dont live for much longer, which is why you're there as skilled nursing care. Because the parent's are idiots and didn't want to withdraw care, and probably wanted everything done, and now you have a train wreck in front of you.
Document what you see, what people say, what you do, and you'll be just fine. Just pay attention, make sure he gets the therapies he needs, and when he gets a pneumonia watch out, hes probably on his last leg. But don't worry too much about it, cause the outcomes for these kids aren't very good anyway (I don't see too many make it to 2 years). I tend to focus my interventions on the parent's if they're even around, thing's like supportive care and dying and not prolonging suffering. In these cases I bet they look at you as the only respite they have, leave you babysitting while probably getting drunk somewhere to escape their troubles.

OMG you could be talking about the little guy I am taking care of right now, home care, single mom with a 5yo sibling. Baby is a 22 wk preemie, chronic lung disorder, short gut, really a sweet little babe, has had PNA and many surgeries on his bowels, Mom insisted on taking him home for whatever time babe has left, I worry constantly I am missing something, his lungs always sound wheezing, congested to me, but the homecare supv NP didn;t seem to concerned, I guess I just keep on doing what I do, meds, TPN feedings, keep him clean and comfortable and hold him whenever I can, sometimes I wonder if we do the right thing keeping these babies alive but thats for another post.