_Oxygen Therapy Dr SUBHASIS ROY Pediatric Oncall新生儿氧疗subhasis博士罗伊儿科课件.ppt

* Presented By : Dr. SUBHASIS ROY , CONSULTANT, SISU SANJIBAN HOSPITAL , SALT LAKE , KOLKATA THE HISTORY 1774 – J. Priestly produced O2 – “Dephlogisticated Air” 1776 – A. L. Lavoisier termed this vital air – OXYGEN Late 1800 – Bonnaire gave O2 to preterm “Blue Baby” with success . 1907 – A. Lane invented NASAL CATHETER 1919 – L. Hill developed O2 TENT. 1920 - O2 therapy became routine for “SICK NEW BORN” O2 THERAPY IN NEONATE VS OLDER CHILDREN ? ?In Neonate –? n O2 reserve less n O2 requirement / kg. higher. n Small change in Fi O2 – large change in Pa O2 n Unrestricted O2 therapy – produce pulmonary / extra pulmonary hazards. ?MORE CAUTION REQUIRED IN NEONATAL O2 THERAPY NEW BORN RESUSCITATION – HOW IMPORTANT O2 IS CURRENT RECOMMENDATION – 100% O2 IN NRP BUT A GROWING OPINION THAT RA CAN BE USED IN PLACE OF O2 Approx 100 million babies born annually, globally - 10 million need resus ! . Cochrane review : RAR group shorter time to first breath and first cry. RAR group – only 25% required 100% backup O2 facility. RAR group – Marginally lower overall mortality. No evidence of HARM in using RA BUT INSUFFICIENT DATA TO RECOMMEND RA OVER 100% O2 NEW BORN RESUS. IS A SCIENTIFIC PROTOCOL BUT MORE AN “ART” THAN A “SCIENCE” IN DEVELOPING COUNTRIES WITH RESOURCE CONSTRAINTS. NOT TO PANIC IF O2 SUPPLY IN LABOUR ROOM IS RESTRICTED OR NOT AVAILABLE. ASSESSMENT OF NEED OF O2 THERAPY ?DURING AND JUST AFTER RESUSCITATION IN NEWBORN Only clinical – n Cyanosis n Heart rate i.e bradycardia n Resp effort n Muscle tone n Response to stimuli ?LATER PART OF THE NEW BORN LIFE ?Clinical – n Cyanosis ? n Heart rate ? n Pattern of breathing i.e. apnoea/Periodic breathing Monitoring - n ABG – PaO2 < 50 mm.Hg. ? n Trans cutaneous oxygen monitoring ? n Pulse oximetry - SpO2 <