Page 606 - Clinical Application of Mechanical Ventilation

572 Chapter 17

The ECMO procedure is expensive and requires around-the-clock monitoring by
specially trained personnel, which increases the cost tremendously. The high cost is
often offset, however, by a decreased number of days spent in the hospital. Patients
receiving ECMO averaged 25 days in the hospital, compared to 76 days for those
treated conventionally (Wagner, 1989).

SUMMARY

Neonatal mechanical ventilation is an area that requires additional training and clini-
cal experience beyond the basics of respiratory care. Neonates should not be viewed
as small adults because the ventilator settings, normal values, and treatment plans are
all unique and sometimes wearisome to manage. This is particularly true for respira-
tory care practitioners who “wear more than one hat” and work in both the adult and
neonatal intensive care units.
Since the materials presented in this chapter are relevant to actual clinical practice,
they should be very useful to respiratory care students as they prepare to train and
practice in the neonatal intensive care units. For seasoned practitioners, the reference
sources should provide additional information on the topics presented in this chapter.

Self-Assessment Questions

1. Intubation of neonates following delivery is indicated under all of the following conditions except:
A. meconium staining of amniotic fluid. C. Apgar score greater than 8.
B. difficulty ventilating by bag and mask. D. presence of diaphragmatic hernia.

2. For neonates below 1,000 g body weight, the proper size of laryngoscope blade should be size _______
and endotracheal tube size _______ (internal diameter, mm):
A. 0, 1.5 C. 1, 1.5
B. 0, 2.5 D. 1, 2.5

3. The most common cause of respiratory distress syndrome in newborns is:
A. surfactant deficiency. C. congenital heart disease.
B. oxygen toxicity. D. low body weight.

4. A preterm infant has a diagnosis of respiratory distress syndrome. The therapist should expect to read in
the chart that the neonate showed all of the following signs except:
A. expiratory grunting. C. apnea.
B. nasal flaring. D. chest retraction.

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