On arrival at NICU, Ralph was put on to cycle pressure-limited ventilation with pressures 24/5, rate

On arrival at NICU, Ralph was put on to cycle pressure-limited ventilation with pressures 24/5, rate of 40 to maintain adequate tidal volumes he required 43 per cent oxygen. Umbilical lines were sited and a chest X-ray was performed which showed a white-out. Ralph’s arterial blood gas at 5 hours of age was pH 7.20, PaC 8.8kpa, Pa 6.1kpa. What would you do next and why? At 12 hours of age, Ralph was given a second dose of surfactant. His arterial blood gas a few hours later was pH 7.39, PaC 5.1kpa, Pa 7.5kpa. What would you do next and why? The following day, Ralph has had his cares performed.

View complete question »On arrival at NICU, Ralph was put on to cycle pressure-limited ventilation with pressures 24/5, rate of 40 to maintain adequate tidal volumes he required 43 per cent oxygen. Umbilical lines were sited and a chest X-ray was performed which showed a white-out. Ralph’s arterial blood gas at 5 hours of age was pH 7.20, PaC 8.8kpa, Pa 6.1kpa. What would you do next and why? At 12 hours of age, Ralph was given a second dose of surfactant. His arterial blood gas a few hours later was pH 7.39, PaC 5.1kpa, Pa 7.5kpa. What would you do next and why? The following day, Ralph has had his cares performed. The nurse notices he is not ventilating adequately and that his tidal volumes have reduced. There is no chest wall movement and Ralph develops a bradycardia with a decrease in his oxygen saturations. What do you think has happened? What would you do next and why? Over the next few days Ralph’s condition improves. His ventilation is weaned to pressures of 14/5, rate 40 and Fi is now between 21-25 per cent. He is given a loading dose of caffeine and is successfully extubated to nasal CPAP 6cm O. What condition do you think Ralph presented with? What other aspects of Ralph’s care need to be addressed?

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