A full-term neonate shows signs of respiratory distress after delivery by cesarean section. The baby is placed on nasal CPAP at 4 cm H2O with an FIO2 of 0.6
The ABG results on these settings are: pH = 7.32, PaCO2 = 45 mm Hg, PaO2 = 48 mm Hg, SaO2 = 70%, HCO3? = 22 mEq/L. The respiratory therapist should recommend which of the following?
a. Intubate and mechanically ventilate.
b. Increase the FIO2 to 0.7.
c. Increase the CPAP to 6 cm H2O.
d. Intubate and use ventilator CPAP.
ANS: C
The ABG results show that the neonate is adequately ventilated. This eliminates the need for NIPPV because the CPAP level is not optimized at this time, and the FIO2 is set at a high level. The ABG results also show that the patient has not had an adequate response to the CPAP of 4 cm H2O with an FIO2 0.6. The CPAP can be increased in increments of 1-2 cm H2O until it reaches 10 cm H2O. Intubating for the use of ventilator CPAP would not provide any benefit over noninvasive CPAP and would increase the risk of nosocomial infection.
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