O2 administration in RSV babies

heinz57 · Jun 19, 2016

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 · Jun 20, 2016

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 · Jun 21, 2016

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.

LoveMyBugs, BSN, CNA, RN · Jun 23, 2016

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 · Jul 7, 2016

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...