A preterm neonate is being supported with nasal SiPAP
The baseline CPAP level is set at 6 cm H2O, the high CPAP level at 10 cm H2O, the rate is 20 "sigh" breaths, and the FIO2 is 0.8. The baby's PaO2 on these settings has been steadily declining and is now 48 mm Hg. The physician and respiratory therapist decided to use nasal HFV before intubating and using mechanical ventilation. The initial settings for NHFV for this patient should include which of the following?
a. MAP = 10 cm H2O; frequency = 8 Hz; FIO2 = 1.0
b. MAP = 10 cm H2O; frequency = 10 Hz; FIO2 = 0.8
c. MAP = 6 cm H2O; frequency = 8 Hz; FIO2 = 0.8
d. MAP = 6 cm H2O; frequency = 10 Hz; FIO2 = 1.0
ANS: D
The initial mean airway pressure for nasal HFV is usually set to equal the previous level of CPAP, with a frequency of 10 Hz. Because the nasal SiPAP baseline level was set at 6 cm H2O, the NHFV should be set at that level. The only option with those two set parameters includes the FIO2 of 1.0, which should be titrated down when oxygenation improves.
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