Diferencia entre revisiones de «Neonatal intubation»
Línea 9: Línea 9:
*Cuffed vs uncuffed ETT: controversial<ref>https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/</ref> but cuffed tubes now genearlly considered acceptable<ref>American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.</ref>
*Cuffed vs uncuffed ETT: controversial<ref>https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/</ref> but cuffed tubes now genearlly considered acceptable<ref>American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.</ref>


==Equipment/sizes/numbers==
==Endotracheal Intubation==
{| class="wikitable"
|-
! Age !! Weight(kg) !! Cuffless !! Cuffed !! Depth(cm) !! Blade
|-
| Preterm || <1kg || 2.5 || - || 6-7 || Miller 0
|-
| Preterm || 1-2.5 || 3.0 || - || 7-9 || Miller 0
|-
| Neonate || 2.5-4 || 3.0 || - || 10 || Miller 0
|-
| Example || Example || Example || Example || Example || Example
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| Example || Example || Example || Example || Example || Example
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| Example || Example || Example || Example || Example || Example
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| Example || Example || Example || Example || Example || Example
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| Example || Example || Example || Example || Example || Example
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| Example || Example || Example || Example || Example || Example
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| Example || Example || Example || Example || Example || Example
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| Example || Example || Example || Example || Example || Example
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| Example || Example || Example || Example || Example || Example
|}
 
 
*ETT tube size:  
*ETT tube size:  
**Full term newborn - 3.5-4 uncuffed
**Full term newborn - 3.5-4 uncuffed

Revisión del 02:14 17 may 2020

General considerations

  • Anatomical differences of neonates (compared to adults/big kids):
    • Large occiput--> may need shoulder roll to get ear to sternal notch aligned
    • Relatively larger tongue, small mouth
    • More anterior larynx
    • Larger/floppier epiglottis
    • Short trachea--> easy to mainstem tube, easy for accidental tube dislodgement
  • Cuffed vs uncuffed ETT: controversial[1] but cuffed tubes now genearlly considered acceptable[2]

Endotracheal Intubation

Age Weight(kg) Cuffless Cuffed Depth(cm) Blade
Preterm <1kg 2.5 - 6-7 Miller 0
Preterm 1-2.5 3.0 - 7-9 Miller 0
Neonate 2.5-4 3.0 - 10 Miller 0
Example Example Example Example Example Example
Example Example Example Example Example Example
Example Example Example Example Example Example
Example Example Example Example Example Example
Example Example Example Example Example Example
Example Example Example Example Example Example
Example Example Example Example Example Example
Example Example Example Example Example Example
Example Example Example Example Example Example


  • ETT tube size:
    • Full term newborn - 3.5-4 uncuffed
    • Preemie- gestational age in weeks/10 (e.g. 24-25wker gets a 2.5)
  • Blade:
    • Preemie <1.5kg: 00
    • Full term newborn: 0
    • Neonate/infant: 1
  • ETT depth
    • Newborn/neonate: uncuffed ETT x 3 (cm at lip)
    • Preemie: weight in kg +1 (cm at lip)
  • LMA size
    • Weight in kg/20 + 1
  • Apneic O2 by NC for newborn/neonate: 5L/m
  • Routine vent settings
    • FiO2 100%--> wean
    • PEEP 4-5
    • TV 8-10cc/kg
    • RR 25-35
    • I-time 0.5s

Drugs

  • Atropine premedication
    • Controversial
    • Neonates VERY prone to bradycardia with myriad stimuli, including the vagal stimulation of laryngoscopy
    • May not be needed routinely but should at least have handy in case of bradycardia[3]
    • 0.01-0.03 mg/kg IV/IO

See Also

External Links

References

  1. ↑ https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/
  2. ↑ American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.
  3. ↑ https://pedemmorsels.com/atropine-needed-rsi/
  4. ↑ https://reference.medscape.com/drug/ketalar-ketamine-343099
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