7 September 2016
3-4 Sep 2016 @ Hilton Tokyo Odaiba
Hosted by Fisher & Paykel HealthcareUnlike the legion of seasoned travellers in the paediatric fraternity, this is only my second trip to the land of the rising sun following the earthquake scare, Pneumococcal Conference in Fukuoka 2 years ago. About 300 global experts (10 from Malaysia) in paediatric and neonatal medicine attended this symposium which focused on non-invasive respiratory support strategies.
Hosted by Fisher & Paykel HealthcareUnlike the legion of seasoned travellers in the paediatric fraternity, this is only my second trip to the land of the rising sun following the earthquake scare, Pneumococcal Conference in Fukuoka 2 years ago. About 300 global experts (10 from Malaysia) in paediatric and neonatal medicine attended this symposium which focused on non-invasive respiratory support strategies.
Dr Colin Morley (Melbourne) who facilitated with Dr Katoshi Kusuda (Tokyo) reminisced 40 years experience of ventilating babies. They then used adult ventilators and all babies virtually died and it got the nurses really angry! ETT got blocked ever so often and had to be changed every 2-3 days, impressing the importance of humidification of medical gases.
When CPAP first appeared in the NICU scene, there was much unfettered skepticism. Dr Richard Polin (I learnt foetal and neonatal secrets from him) recalled a critique from a fellow neonatologist; “The fundamental concept of the Kamper study (Acta Paediatr. 1992) is fundamentally flawed. Putting seriously ill babies on CPAP alone gives the clinician much less control of cardio-respiratory function at a time when the baby is at a major risk of a sudden deterioration”.
Low cost high technology CPAP which is god-sent to resource restricted developing nations is now the “gold standard” for non-invasive ventilation of babies. Dr Richard Polin summarized the Columbia experience:
- Early use of CPAP with subsequent selective surfactant administration in extreme preemies results in lower rates of BPD/Death when compared to Rx with prophylactic or early surfactant therapy (LOE1)
- Preemies with RDS and < 1500 grams should be allowed time to demonstrate if they can achieve acceptable ventilation and oxygenation on CPAP. Monitor closely, and if ventilation or oxygenation not improving in 0.6 FiO2, intubate!
- If it is likely that respiratory support with a ventilator is required, early administration of surfactant followed by rapid extubation, is preferable to prolonged ventilation (LOE1)
Similar skepticism emerged when gas was infused into the nostrils via Nasal High Flow (NHF). “It could not work, it must be CPAP!” The two day meeting deliberated the physiology and evidence for NHF benchmarked against nCPAP – next report!
Notwithstanding, heated humidification of the medical gases is central in the care continuum. Dr Colin Morley summarized:
- Medical gases are cold and very dry (in contrast to cool and charming neonatologists)
- Optimal airway humidification is vital.
- Inappropriate humidifier setting or devices may affect clinical outcomes by damaging airway mucosa, prolonging mechanical ventilation or increasing work of breathing
- Infants who are ventilated, receiving CPAP or NHF oxygen all need optimal humidification.
Musa Mohd Nordin
3 Sep 2016
