Fraction of inspired oxygen

The CPAP was maintained for the first 15 minutes after birth, unless escalation to positive pressure ventilation was required or you needed an endotracheal tube.

The initial FiO2 is set at 30, kind of like what most people do, and subsequently adjusted to maintain oxygen saturation to the target range.

After the first 15 minutes, CPAP was standardized to a level of 6 in both groups.

So the CPAP 5 went to 6, the CPAP 8 came down back to 6 until the NICU entry.

The primary objective of the pilot trial is to evaluate the feasibility of conducting the trial.

And safety was evaluated by monitoring predefined adverse events, including pneumothorax, PIE, pulmonary interstitial emphysema, and needing endotracheal intubation during the early postnatal period.

Some predefined exploratory physiological outcomes were assessed, including the pre-ductal oxygen saturation, inspired oxygen fraction, heart rate, and the pre-ductal SpO2 to FiO2 ratio, the S

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The CPAP was maintained for the first 15 minutes after birth unless escalation to positive pressure ventilation was required or you needed an endotracheal tube.

The initial FiO2 is set at 30, kind of like what most people do, and subsequently adjusted to maintain oxygen saturation to the target range.

After the first 15 minutes, CPAP was standardized to a level of six in both groups.

So the CPAP five went to six, the CPAP eight came down back to six until the NICU entry.

It's obviously an important component to understand the threshold that they use for surfactant administration because it will be one of the outcomes that they will measure in terms of how many of these kids did better than others.

The primary objective of the pilot trial is to evaluate the feasibility of conducting the trial and safety was evaluated by monitoring predefined adverse events including pneumothorax, PIE, pulmonary interstitial emphysema, and needing endotracheal intubation during the early postnatal period.

Some predefined expiratory physiological outcomes were assessed including the preductal oxygen saturation, inspired oxygen fraction, heart rate, and the preductal SpO2 to FiO2 ratio, the S on F ratio during the first 15 minutes after birth.

Have you ever used the S on F ratio?

The vent is really just there for the, the positive pressure support.

There are folks who would, generally speaking, I'm painting with a broad brush, there are folks who would generally kind of rule in as far as being appropriate for apnea testing versus a lot of our patients in, like, the medical ICU who maybe have, like, that plus ARDS or something where you clearly are, are not gonna be able to drop their FiO2s.

That kind of like the-- It's, it's a, maybe it's a false dichotomy or it's a simplistic view, but is that at least a, a good thought approach?

Yeah.

He got a few units of blood in the OR.

Now, thirty-six hours out and the FiO2 is climbing.

The PEEP is climbing, and the chest film was clear yesterday, now has bilateral fluffy opacities.

The overnight note says fluid overload and diuresis.

You walk in, what's the n- one number you're gonna calculate before you accept that?

So here, John, we're gonna start with the PF ratio.

That's our P little ao2 divided by the FiO2, but we're not gonna stop there.

Bilateral opacities plus hypoxemia can and should certainly make you think about ARDS, but it could also be hydrostatic pulmonary edema or it could be both.

But in this particular case, airing on the side of a larger tube may provide more airflow and ventilation for the patient.

As far as ventilation strategy goes, we want to typically... assist control volume with a tidal volume around 6-8 cc per kilogram, 100% FiO2 just to start with, and you can titrate that down as needed.

Your respiratory rate, you want to run it on the lower side.

You can tolerate hypercapnia as long as you're performing some degree of ventilation.

If you find that you are breath trapping, if the chest is just kind of inflating, if the patient, if your plateau pressures become really high all of a sudden, The first thing you need to do is disconnect the endotracheal tube from the ventilator and bag the patient.

Well, first disconnect it and just see, is there a big rush of air out? You can also squeeze on the chest to try and push out any residual air.

Reconnect them to your bag and start bagging them with a hundred percent FiO2 and see how they feel to bag They will be they there's a will be a lot of resistance when you're bagging a severe asthmatic and then you'll want to also then evaluate for pneumothorax.

So using your ultrasound or chest x-ray or just auscultation, look at both lungs, evaluate to see if one side has decreased lung slide or decreased breast sounds because these patients are at a high risk of pneumothorax because of their high intrathoracic pressures.

So I wanted to give you some blood gas results and find out then what that would take you towards in terms of optimizing his ventilatory status.

So this patient is currently on 60% FiO2.

His respiratory rate is 10.

His tidal volume is eight mils per kilo.

You wanna increase your respiratory rate.

Uh, tidal volume seems to be okay, although, you know, somewhere between six and eight, so also you're using a lung protective strategy as well.

The, uh, uh, PO2 or the FiO can be controlled by the FiO2, which is, which is okay.

I mean, it's not perfect, but it's not something like we have to go up to a hundred percent FiO2 right now.