NPS Respiratory Management Flashcards

What is the normal PaCO2 range targeted during mechanical ventilation of a neonate with RDS?

Answer: 35–45 mmHg

Target PaCO2 of 35–45 mmHg is appropriate for term neonates; permissive hypercapnia (45–55 mmHg) may be acceptable in preterm infants on lung-protective ventilation.

Which condition is the most common cause of air leak syndrome in mechanically ventilated neonates?

Answer: RDS with high PIP ventilation

Excessive peak inspiratory pressure (PIP) during mechanical ventilation for RDS is the most common cause of pulmonary air leak (pneumothorax, PIE) in neonates.

A neonate with congenital diaphragmatic hernia (CDH) is intubated at birth. Why is bag-mask ventilation avoided in CDH?

Answer: It inflates herniated bowel, worsening lung compression

Bag-mask ventilation forces air into the stomach and herniated intestinal loops, further compressing the hypoplastic lung and worsening respiratory failure.

What is the significance of a pulmonary interstitial emphysema (PIE) finding on chest X-ray in a ventilated preterm neonate?

Answer: It represents air dissecting into lung interstitium, a risk factor for tension pneumothorax

PIE represents air trapped in the pulmonary interstitium and perivascular sheaths, and can progress to pneumothorax, pneumomediastinum, or pneumopericardium.

Which parameter primarily determines oxygenation in a neonate on high-frequency oscillatory ventilation (HFOV)?

Answer: Mean airway pressure (MAP)

Mean airway pressure (MAP) is the primary determinant of lung recruitment and oxygenation in HFOV, while amplitude controls CO2 elimination.

A preterm neonate on CPAP at 6 cmH2O has increasing work of breathing and FiO2 requirement >40%. What is the next appropriate intervention?

Answer: Administer inhaled surfactant via LISA/MIST technique

LISA (Less Invasive Surfactant Administration) or MIST (Minimally Invasive Surfactant Therapy) allows surfactant delivery without intubation in neonates failing CPAP.