Bella isn’t having a great night.
Without boring you with venous and arterial blood gas numbers, I will tell you that her numbers are all off. She is doing worse instead of better. They have fiddled with her ventilator settings. She was paralyzed at 9:30 PM. This has improved her O2 sats to 93 to 94 (a ten point increase from before being paralyzed).
She is receiving IV Lasix in good healthy does. They did get the arterial line.
If she continues to do badly (RN friends – our last blood gas was CO2 of 59 and O2 of 45 arterial blood gas), the next step is the oscillator.
Bella, Bella, Bella.
To understand more about breathing support, here is a list from the internet (http://www.sjmercyhealth.org/body.cfm?id=527):
Nasal CPAP (Continuous Positive Airway Pressure)
Nasal CPAP is often the initial type of breathing support that we use. It involves the use of nasal prongs or a mask that fits over the nose and gives the baby help by providing extra pressure when he/she takes a breath. Nasal CPAP is used for infants with mild or moderate breathing problems and those with pauses in their breathing (apnea).
Conventional ventilators are used when infants fail to improve with nasal CPAP or when they are in significant respiratory distress. This type of respiratory support requires that an infant have a tube (endotracheal tube) placed in their windpipe. The tube is then connected to the ventilator. Conventional ventilators provide pressure directly to the lungs and can either assist a baby with their own breaths or provide breaths to babies that are not breathing on their own.
High Frequency Oscillator
When a conventional ventilator fails to provide an adequate amount of breathing support or when we become concerned that the conventional ventilator may be causing additional harm to the lungs we may change to a special type of ventilator called a high frequency oscillator. This type of ventilator also requires that a tube be placed in the infant’s windpipe. The oscillator ventilator provides constant pressure to the baby’s lungs that keeps them inflated with air. It then vibrates very rapidly which can often be seen by watching the infant’s chest wiggle.