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Guide to Neonatal Ventilation Case Study 4

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Case Study 4: High Frequency Oscillatory Ventilation (HFOV)
  • Baby Thomas is a 28 1/7-weeks’ gestation, male infant who is DOL 3 (post-menstrual age: 28 4/7 weeks). He is intubated and on mechanical ventilation since DOB with the current diagnosis of severe acute RDS status post (s/p) surfactant X 2 on DOB. He has been managed on SIMV pressure limited ventilation since birth and his current settings are FiO2 0.65, Rate 45/minute, PIP 25 cm H2O, PEEP 6, Ti 0.4 seconds. Serial CXRs show a white-out bilaterally with a ground-glass appearance and poor lung expansion (7 ribs); no air leak and good ETT placement. Baby Thomas has required an increasing FiO2 to maintain target SPO2 saturations. The decision is made to place Thomas on high frequency oscillatory ventilation (HFOV).

  • Questions
    1. What are the basic principles of HFOV?
    2. What are the clinical applications of HFOV?
    3. Based on the above case study, what would be the rationale for choosing HFOV for Thomas at this time?

  •  For more information to answer these questions refer to the following learning resources.

  • Available CEU's (processing fees required)

  • About the Contributor

    AnnMarie Barber, MS, MSN, CRNP, is an NNP with over 19 years of experience practicing in the Philadelphia area. She received her BSN and Masters in Human Organization Science degrees from Villanova University and her MSN degree from the University of Pennsylvania. Since 2013 she has been a Clinical Nurse Educator for Mallinckrodt Pharmaceuticals providing expert consultation and education to neonatal clinicians regarding the diagnosis and treatment of PPHN and the utilization of inhaled nitric oxide. She has also been a speaker at several conferences and clinical meetings including the Virginia Society of Respiratory Care Conference, the Robert Wood Johnson University Respiratory Conference, and ANN's 16th National Neonatal Nurses Conference. She served on ANN's Executive Committee from 2014 to 2016.


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