RAM Cannula in the NICU

[juliachloe]

Curious to know if any bedside nurses like this device. We started using it in our facility this year. We did not receive any education on it. I understand that intubation can be incredibly traumatizing to a patient's trachea and lungs, especially the tiniest of babies. I understand that the longer they are on the ventilator, the more likely they are to develop BPD. I get the purpose of the device. What I don't understand is why physicians choose to torture these tiny babies by keeping them on this device when they very obviously cannot tolerate it.

I watch these babies huff and puff (RR >100), retract like mad (moderate to severe suprasternal, intercostal, subcostal and substernal), eventually exhaust themselves so much so that they become lethargic and eventually start to have apnea...and these doctors STILL do not want to intubate. When is enough enough? How is that any kind of quality of life? They spend the first 2 months in a daze because they are so exhausted from breathing. They have have had thousands of desaturations, and likely hundreds of severely hypoxic episodes in that amount of time. Forget how damaging that can be to their brains. I guarantee that if I was a parent in the NICU and FULLY informed about the care my baby was receiving and the likely outcomes, I would choose for my baby to receive a trach because they simply cannot tolerate extubation rather than them being tortured for months and then wind up being bed-ridden for the rest of their lives because of the insult their brain took while in the NICU. I have spoken at length with our docs and they firmly believe in this device, regardless of how the baby is doing and the outcome. One thought that the only time he would consider intubation is when the baby is coding. He stated that most infants with trachs wind up having CP anyway. I understand they are medicine and I am nursing but at some point the two have to come together and agree on something. I can advocate until exhaustion and it never seems to be enough.

Is this just something in my unit or are other nurses experiencing this as well regarding the RAM?