55461_FMXx_ttlpg.indd Neonatal Respiratory Care Handbook Elgloria A Harrison, MS, RRT-NPS Associate Professor Department of Nursing and Allied Health Respiratory Therapy Program University of the District of Columbia 9/28/09 3:07:06 PM World Headquarters Jones and Bartlett Publishers 40 Tall Pine Drive Sudbury, MA 01776 978-443-5000 info@jbpub.com www.jbpub.com Jones and Bartlett Publishers Canada 6339 Ormindale Way Mississauga, Ontario L5V 1J2 Canada Jones and Bartlett Publishers International Barb House, Barb Mews London W6 7PA United Kingdom Jones and Bartlett’s books and products are available through most bookstores and online booksellers To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jbpub.com Substantial discounts on bulk quantities of Jones and Bartlett’s publications are available to corporations, professional associations, and other qualified organizations For details and specific discount information, contact the special sales department at Jones and Bartlett via the above contact information or send an email to specialsales@jbpub.com Copyright © 2011 by Jones and Bartlett Publishers, LLC All rights reserved No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner The author, editor, and publisher have made every effort to provide accurate information However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures described Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial Research, clinical practice, and government regulations often change the accepted standard in this field When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product This is especially important in the case of drugs that are new or seldom used Additional photographic and illustration credits appear on pages 261 and 262, which constitute a continuation of the copyright page Production Credits Publisher: David Cella Associate Editor: Maro Gartside Production Assistant: Tina Chen Marketing Manager: Grace Richards Manufacturing and Inventory Control Supervisor: Amy Bacus Composition: Publishers’ Design and Production Services, Inc Assistant Photo Researcher: Carolyn Arcabascio Cover Design: Scott Moden Printing and Binding: Imago Group Cover Printing: Imago Group Library of Congress Cataloging-in-Publication Data Harrison, Elgloria A Neonatal respiratory care handbook / Elgloria A Harrison p ; cm Includes bibliographical references and index ISBN 978-0-7637-5546-1 Respiratory insufficiency in children—Handbooks, manuals, etc. Newborn infants—Diseases—Handbooks, manuals, etc. I Title [DNLM: Lung Diseases—therapy. Child. Infant. Lung Diseases—diagnosis. WS 280 H318n 2009] RJ312.H37 2009 618.92'01—dc22 2009024206 6048 Printed in Hong Kong 13 12 11 10 09 10 9 8 7 6 5 4 3 2 5467 Book.indb 9/28/09 11:56:00 AM Dedication This book is dedicated to my daughter, Delisie, who turned out to be a wonderful, funny comedienne; to Moma, Lola, and Misty, my furry companions; to my family, who has always been in my corner; to my neighbor, Vanessa, who has been a source of encouragement throughout this project; to my mentor, Dr Felecia Moore Banks, who paved the path for this project; and to my colleagues at the University of the District of Columbia, who have been my cheering squad I could not have done this book without you Special thanks to Dr J Bert Bunnell and Bunnell Incorporated 5467 Book.indb 9/28/09 11:56:01 AM 5467 Book.indb 9/28/09 11:56:01 AM Contents Preface vii Contributor ix Chapter Acute Respiratory Distress Syndrome (ARDS) Chapter Infant Respiratory Distress Syndrome (IRDS) 37 Jacqueline Haymon Smith, BS, RRT-NPS Chapter Asthma 55 Chapter Chronic Lung Disease of the Newborn 87 Chapter Cystic Fibrosis 103 Chapter Upper Airway Inflammatory Diseases 119 Chapter Bronchiolitis 133 Chapter Air Leak Syndromes 149 Chapter Congenital Heart Disease 187 Chapter 10 Neuromuscular Diseases 219 Glossary 239 Index 253 Credits 261 5467 Book.indb 9/28/09 11:56:01 AM 5467 Book.indb 9/28/09 11:56:01 AM Preface “Let us dare to read, think, speak and write.” John Adams, 1765 When considering what type of book to write, my mind flooded with the great torrent of knowledge already available on the subject of neonatal and pediatric respiratory care As I continued to reflect on the everyday job of a respiratory therapist in a neonatal intensive care unit (NICU) or a pediatric intensive unit (PICU), it occurred to me that a concise guidebook that actually provides both illustrations and text on how to assemble some of the most complex respiratory equipment and includes explanations for the purpose of this equipment would be beneficial to a respiratory therapist There are a number of books on respiratory therapy equipment and even more books on the pathophysiology and management of the neonatal and pediatric patient; this book does not attempt to replace any of those books This little respiratory compilation is a handy pocket-size guidebook, one that is easy to understand, with an excellent display of images, designed with the new respiratory therapist or the respiratory student in mind My goal is to share with the reader my experience in the NICU and PICU, where it is necessary to understand the array of equipment that has been developed for this patient population In the NICU and PICU world, we learn quickly how to adapt this equipment to the neonate or pediatric patient Of recent years, manufacturers have been more responsive to those of us who work in these areas: there has been a proliferation of equipment designed just for the neonate and the pediatric patient Having said this, it becomes an ongoing challenge for educators, whether in academia or the hospitals, to keep up with the maze of available equipment and to be able to ensure competency of each student or new graduate respiratory therapist This task can sometimes be overwhelming; thus this book will be a welcome addition to an educator regardless of the setting It is my desire that a new respiratory therapist graduate will use this book as a reminder of how to set up equipment in the NICU and 5467 Book.indb 9/28/09 11:56:01 AM viii Preface PICU and that this book will enable the respiratory therapist to become more proficient in the NICU and PICU areas I might add that this book is not designed to be a substitute for an actual orientation or a class on neonatal/pediatric respiratory care but will simply add to the respiratory therapist’s current knowledge base 5467 Book.indb 9/28/09 11:56:01 AM Contributor Jacqueline Haymon Smith, BS, RRT-NPS Clinical Manager of Respiratory Care Georgetown University Hospital Washington, DC 5467 Book.indb 9/28/09 11:56:01 AM Glossary 249 Ribavirin (Virazole) A type of medication used to treat patients with respiratory syncytial virus It is delivered through a small particle aerosol generator (SPAG) Patients with chronic lung disease, cardiac defect, or patients who were immunosuppressed as with HIV or organ transplantation are candidates to receive this medication Saturation Also called oxygen saturation, this is a percentage of arterial hemoglobin that is saturated with oxygen This measurement is typically seen with the use of a pulse oximeter attached to the patient Small particle aerosol generator (SPAG) This unit was designed specifically to administer Ribavirin to patients with respiratory syncytial virus Spinal muscular atrophy (SMA) This hereditary disease results in weakness and muscle wasting in the arms and legs of infants and children The three types of SMA are determined by the age of onset and the symptoms involved SMA is characterized by a missing gene, called the survival motor neuron gene, which is responsible for the production of protein necessary for the proper function of the motor neuron Spontaneous pneumothorax In this condition, free air in the pleura spaces results from a weakening alveolar membrane Surfactant Surfactant is a pulmonary agent secreted by the type II alveolar cells that decreases surface tension of the fluid lining the lungs, permitting expansion of the alveoli, which results in gas exchange Surfactant is commercially available and is used in surfactant replacement therapy for the treatment of patients with respiratory distress syndrome of the newborn Synagis (palivizumab) A Food and Drug Administration (FDA) approved vaccine for the treatment of high-risk infants against the respiratory syncytial virus High-risk infants include infants born prematurely (before 35 weeks), those with heart defects, and those who have chronic lung disease of the newborn These infants may be particularly susceptible to 5467 Book.indb 249 9/28/09 11:57:05 AM 250 Glossary getting lung infections This vaccine is injected intramuscularly during the respiratory syncytial virus season every 28 to 30 days Tension pneumothorax This occurs when the lung tissue has already suf- fered damages It can occur as a result of scar tissue Scar tissue tends to make the lung walls tight, which prevents air from entering; therefore, air that enters the lung parenchyma cannot escape, causing a buildup of pressure inside the lung walls This pressure causes a shift in cardiac structures, which decreases venous return and decreases cardiac output Tension pneumothorax is a medical emergency and must be relieved immediately Tetralogy of Fallot In this congenital heart defect, there is a combination of four abnormal heart structures: (1) ventricular septal defect—a hole between the walls of the ventricles, (2) narrowing of the pulmonary outflow tract, (3) an aorta that arises from the right and left ventricles, and (4) a thick muscular wall of the right ventricle An infant born with tetralogy of Fallot may not show cyanosis immediately, but may develop cyanotic episodes later Total anomalous pulmonary venous return A defect in which the pulmo- nary veins are missing and blood is redirected back to the right atrium rich in oxygen, which means that there is no oxygen-rich blood going to the body This is a life-threatening emergency requiring immediate attention Transillumination A procedure used in most nurseries to detect a pneumothorax at the bedside A fiber optic light is placed on the chest to light up the chest wall An increased amount of light might mean free air in the chest cavity Transillumination is not used as a substitute for a chest x-ray Transposition of the great vessels In this congenital defect, the two main arteries are connected to the wrong heart chambers Here the aorta is connected to the right ventricle and the pulmonary artery is connected 5467 Book.indb 250 9/28/09 11:57:05 AM Glossary 251 to the left ventricle Infants born with transposition of the great vessels will have some other type of cardiac defect, such as an atrial septal defect, which will allow for the mixing of deoxygenated blood with some oxygenated blood Infants with this defect require surgery usually within the first few weeks of life Tricuspid atresia A structural defect of the tricuspid valve The valve is either missing or broken, causing a blockage to pulmonary blood flow from the right atrium to the right ventricle through the pulmonary trunk to the lungs Ventricular septal defect This condition is characterized by one or more holes in the wall between the right and left ventricles It is the most common congenital heart defect observed Small ventricular septal defects can self-close and are asymptomatic Large ventricular septal defects cause too much blood to be pumped to the lungs, which leads to congestive heart failure 5467 Book.indb 251 9/28/09 11:57:05 AM 5467 Book.indb 252 9/28/09 11:57:05 AM Index A Acapella valve, 112, 113 Acquired heart disease, 208 Acute lung injury (ALI), 2, 8–9 criteria chain for, treatment for, 13–32 Acute respiratory distress syndrome (ARDS), 1–35, 211 characteristics of, clinical case review, 4–5 clinical signs of, congestive heart failure versus, conventional mechanical ventilation, 13, 15–17 criteria chain for, defined, 2–3 extracorporeal membrane oxygenation, 28–30 heliox administration, 30 inhaled nitric oxide, 22–26 mortality rate of, oxygen, 20 partial liquid ventilation, 30–32 prone patient positioning, 26–28 research on, 8–13 respiratory therapist initial response, 5–8 treatment for, 13–32 ventilation, 20–22 vital signs and, Adenovirus, 134 Adult respiratory distress syndrome, Advair, 115 Aerobid, 116 African Americans asthma in, 58 cystic fibrosis and, 104 Air leak syndromes, 149–85 characteristics of, 154–61 chest x-rays and, 161–62 defined, 151–54 distinguishing, 161–62 high-frequency jet ventilation, 164–68 high-frequency oscillator ventilation for, 174–77 oxygen, 178 pneumomediastinum, 153, 159 5467 Book.indb 253 pneumopericardium, 154, 159 pneumothorax, 151–52, 154–55 pulmonary interstitial emphysema, 154, 160–61 research on, 162–63 treatment for, 163–83 ventilation, 178–79, 183 Airway edema, 59 normal versus abnormal, 57 Airway clearance therapies, 113 Airway pressure release ventilation (APRV), 14, 15, 16 Albuterol, 99 for bronchiolitis, 139–40 for cystic fibrosis, 114, 115 Allergens, 83 American Academy of Pediatrics (AAP), 150, 200, 207, 216 American College of Chest Physicians (ACCP), 110 recommendations for airway clearance therapies, 113 American European Consensus Conference (AECC), 2, American Heart Association, 188, 191 American Thoracic Society (ATS), 226, 228, 236 Andersen, Dorothy, 104, 107 Antenatal steroids, 92 Antibiotics for chronic lung disease of the newborn, 98, 99 for cystic fibrosis, 114, 116 Anticholinergic, 82 for chronic lung disease of the newborn, 99 Anti-inflammatory medications, for cystic fibrosis, 114 ARDS Clinical Research Network (ARDSnet), 9, 11 Arterial blood gas collection, 69 Asian Americans, cystic fibrosis and, 104 Assisted coughing, 228 Asthma, 55–85 anticholinergic for, 82 9/28/09 11:57:05 AM 254 Index arterial blood gas collection, 69 bronchiolitis versus, 136 causes of, 59 characteristics of, 62–63 chronic lung disease of the newborn versus, 90 clinical presentation of, 58–59 cockroaches and, 61 corticosteroids for, 82 defined, 56–58 delivery devices for, 69–83 drug dosages for management of, 73–74 drugs for, 82–83 dust mites and, 61 healthcare costs for, 58 helium-oxygen therapy, 78–82 impairment reduction, 68 NAEPP guidelines for severe exacerbations, 70 oxygen therapy, 69 patient presentation for, 84 population affected by, 57–58 research on, 63–69 risk reduction, 69 severe asthma exacerbation versus, 60 severe exacerbation, 57 severity, 61–62 short-acting beta -agonist (SABA), 72, 75 signs and symptoms of, 60 smoking and, 63 treatment of, 69–83 triggers, 59 Atrial septal defect (ASD), 191, 193, 198–200 characteristics of, 204–5 ostium primum defect, 205 ostium secundum defect, 205 sinus venosus defect, 205 symptoms of, 205 treatment of, 214 Atrovent, 115 Azmacort, 116 B Bacteremia, 136 Bacterial endocarditis, 208–9 Bacterial tracheitis, bronchiolitis versus, 136–37 Bag mask device, 158 Ball-valve mechanism, 42 Barotrauma, 145, 150 Beclomethasone (QVAR), 116 Bias flow, 20, 178, 180 5467 Book.indb 254 Bronchiectasis, cystic fibrosis versus, 106 Bronchiolitis, 90, 123, 133–48 asthma versus, 136 bacterial tracheitis versus, 136–37 bronchodilators, 139–40 characteristics of, 135–36 croup versus, 137 defined, 134–35 delivery devices for, 141–43 heliox for, 143, 144 mechanical ventilation for, 144–46 population affected by, 135–36 research on, 137–38, 138–46 respiratory diseases versus, 136–37 symptoms for, 135 Synagis, 139 Bronchitis, cystic fibrosis versus, 106 Bronchoconstriction, 58 Bronchodilators albuterol, 139 for bronchiolitis, 139–40 for cystic fibrosis, 114 racemic epinephrine, 140 short-acting, 97–98 therapy, 138 Xopenex, 139 Bronchopulmonary dysplasia (BPD), 166 Budesonide, 116, 125, 126 Bunnell, J Bert, 164 C Cardiac defects mechanical ventilation with, 210 surgical treatment for, 213 Cardiac tamponade, 160 Cardiomyopathy, 208–9 Centers for Disease Control and Prevention (CDC), 105, 225 Chanock, Robert, 137 Chest physiotherapy, for cystic fibrosis, 114 Chest x-rays, 161–62 Choanal atresia, 46 Chronic lung disease of the newborn (CLD), 87–101 characteristics of, 88–90 chronic respiratory illnesses versus, 90 defined, 88 drug dosages for, 99 nutritional support for, 93 nutrition strategy for, 98–100 pharmacology therapy for, 93, 97–98 population affected by, 88 9/28/09 11:57:05 AM prevention, 92 research on, 90–92 signs of, 89 stages of, 89–90 treatment for, 92–100 ventilator and oxygen strategy, 92, 96–97 ventilator management for, 96–97 Chronic obstructive pulmonary disease (COPD), 88 Cigarette smoking, asthma and, 63 Circulation, normal fetal, 189 Coarctation of the aorta, 201–2 characteristics of, 206 symptoms of, 206–7 treatment of, 215–16 Cochrane Collaboration, 32 Cockroaches, asthma and, 61 Combivent, 115 Computer tomography (CT), 163 Congenital diaphragmatic hernia (CDH), 38, 40, 43, 45 treatment for, 52 Congenital heart disease, 187–218 acquired heart disease and, 208 characteristics of, 202–7 defined, 191–202 distinguishing, 207–9 noncyanotic heart disease, 198–202 research on, 209–10 tetralogy of fallot, 191, 192, 202–3, 211 total anomalous pulmonary venous return, 195, 198, 199, 204, 213–14 transposition of great vessels, 191–95, 203, 211–12 treatment for, 211–16 tricuspid atresia, 195, 197, 203–4, 212–13 Congenital muscular dystrophy, 223–24 Congestive heart failure (CHF), 188, 207–8 symptoms of, 207–8 treatment of, 216 Continuous nebulizer, 78, 79 therapy with SABA, 75–77 Continuous positive airway pressure (CPAP), 15, 47, 48, 96 Conventional mechanical ventilation, for acute respiratory distress syndrome, 13, 15–17 Conventional ventilation, 164 with high-frequency oscillator ventilation, 176 Conventional ventilation (CV), 175 Corticosteroid anti-inflammatory drugs, 116 5467 Book.indb 255 Index 255 Corticosteroids, 82 for chronic lung disease of the newborn, 98 for upper airway inflammatory diseases, 126 Coughlator, 234–36 Croup, 120, 130 bronchiolitis versus, 137 epiglottitis versus, 121 steeple sign in, 124 steroid therapy for, 123 treatment for, 127 Cyanotic heart diseases, 188, 217 characteristics of, 202–4 Cystic fibrosis (CF), 103–18 characteristics of, 105–6 chest physiotherapy, 114 defined, 104–5 discovery of, 104 high-frequency chest wall oscillation, 110, 111 lung transplantation and, 109 manual chest physiotherapy for, 110 medications for, 114 nutritional support, 114 pancreatic enzyme replacement therapy, 114 population affected by, 104–5 pulmonary illnesses versus, 106–7 research on, 107–9 respiratory therapy, 109–13 signs and symptoms of, 106 surgical options, 114 treatment for, 109–16 vibratory devices, 110 Cystic fibrosis transmembrane conductance regulator (CFTR) gene, 104 D Delivery devices for bronchodilators, 141–43 meter dose inhaler, 141 ribavirin, 142–43 small volume nebulizer, 141 Dexamethasone, 125, 126 Diphtheria, 120 Diuretics, for chronic lung disease of the newborn, 98, 99 Dosage for asthma management, 73–74 for treatment of chronic lung disease of the newborn, 99 9/28/09 11:57:05 AM 256 Index Duchenne, Guillaume, 221 Duchenne muscular dystrophy (DMD), 220, 221 characteristics of, 222–23 spinal muscular atrophy versus, 224 treatment of, 227–36 Ductus arteriosus, 190 Ductus venosus, 190 Duoneb, 115 Dust mites, asthma and, 61 E Epiglottitis, 120, 130 croup versus, 121 historical facts about, 125 thumb sign and, 122 treatment for, 127, 129 Exposure to tobacco smoke (ETS), 63 Extracorporeal membrane oxygenation (ECMO), 14, 23, 28–30, 48, 51 diagram of, 29 inclusion criteria for, 30 F Federal Drug Administration (FDA), 107 Flovent, 116 Flutter valve, 111 Food and Drug Administration (FDA), 175 Foramen ovale, 190 Foreign-body airway obstruction (FBAO), 122 Frequency, in ventilation, 20–21, 178–79 Fundamentals of Respiratory Care (Egan), 2, G Gastroesophageal reflux (GERD), 62, 63 chronic lung disease of the newborn versus, 90 Graft, 216 Group B streptococcus (GBS), 44 H Haemophilus influenzae type B, 120, 126, 130 Heart formation of structures, 190 normal fetal circulation, 189 Heated, humidified high flow nasal cannula, 93 Heliox administration, 14, 30 with mechanical ventilation, 32 with nebulizer, 31 Helium-oxygen therapy (heliox therapy), 78–82 5467 Book.indb 256 for bronchiolitis, 143, 144 mask, 81 High flow oxygen and aerosol therapy, 93 High-frequency chest wall oscillation, 110, 111 High-frequency chest wall oscillatory vest, 229 High-frequency jet ventilation (HFJV), 22, 23, 47, 48, 164–68 calibration of, 173 with iNO, 25, 26 jet box, 168 optimal PEEP during, 172 settings, 167 steps for, 169–71 troubleshooting, 173–74 High-frequency oscillator ventilation (HFOV), 14, 17–20, 21, 47, 48, 164 for air leak syndromes, 174–77 conventional ventilation and, 176 face panel, 177 operation of, 19–20, 175–77 starting settings, 180 troubleshooting, 181–83 High heated humidity nasal cannula, 49 High humidity nasal cannula, 95 Hourglass sign See Steeple sign Human metapneumovirus, 134 Humidity therapy, for upper airway inflammatory diseases, 126, 127 Hyaline membrane disease (HMD), 39, 41, 45 Hyperinsufflation therapy, 234–36 Hypersensitivity, 58 Hypertonic saline, 116 Hypoxemia, 12 I Infant Flow device, 49 Infant respiratory distress syndrome (IRDS), 37–54 characteristics of, 41–44 clinical note on, 40 conditions that mimic, 44–46 defined, 38–41 research on, 46–48 symptoms of, 41–42 treatment, 48–51 Influenza, 134 Inhaled nitric oxide (iNO), 14, 22–26, 48, 51 conventional ventilator with, 24 high-frequency jet ventilation with, 25, 26 9/28/09 11:57:05 AM Inhaled steroids, for chronic lung disease of the newborn, 99 Inspiratory time, in ventilation, 21, 179 Intermittent positive pressure breathing machine (IPPB), 228 Intrapulmonary percussive ventilation (IPV), 112, 113, 114, 228, 234 Invasive inflation, 236 Irritants, 83 J Johns Hopkins University Children’s Heart Center, 213 L Laryngotracheobronchitis (LTB), 121 Laryngotracheobronchopneumonitis (LTBP), 121 LifePulse, 164, 165, 166, 168, 169–71 calibration of, 173 troubleshooting, 173–74 Low birth weight infants, chronic lung disease of the newborn and, 91 Low flow nasal cannula, 93 Lung recruitment maneuver, 17 Lung transplantation, cystic fibrosis and, 109 Lung whiteout, 90 M Manual chest physiotherapy, 108, 110, 231–33 for neuromuscular diseases, 228 Manual percussor, 230 Mean airway pressure, 20, 178, 180 Mechanical percussor, 230 Mechanical ventilation for bronchiolitis, 144–46 with cardiac defects, 210 with heliox, 32 initial settings for, settings for, 146 Mechanical ventilators, 83, 93 Meconium aspiration syndrome (MAS), 38, 39–40, 42, 45, 151 signs of, 42–43 treatment for, 52 Meningitis, 136 Merosin, 224 Metered dose inhaler (MDI) for bronchiolitis, 141 Mist tent, 127 5467 Book.indb 257 Index 257 Mucolytics, for cystic fibrosis, 114, 115–16 Mucomyst, 115 Muscular Dystrophy Association, 223 Myasthenia gravis, 46 congenital, 46 neonatal, 46 Myocarditis, 208–9 N Nasal cannula, 93, 141 high flow, 142 neonatal, 94 pediatric, 94 National Asthma Education and Prevention Program (NAEPP), 56, 62, 63, 68 drug dosages for management, 73–74 stepwise chart, 64–67 National Center for Healthy Housing (NCHH), 68 National Heart, Lung, and Blood Institute (NHLBI), 9, 11, 88, 91 National Institute of Neurological Disorders and Stroke (NINDS), 220 National Institutes of Health (NIH), 9, 38 National Survey on Environmental Management of Asthma, 63 Nebulizer for chronic lung disease of the newborn, 99 continuous, 78, 79 heliox administration with, 31 small volume, 77 units, 80 Needle aspiration, 160 Neonatal nasal cannula, 94 Neonatal pneumonia, 44 Neuromuscular diseases, 219–38 characteristics of, 221–23 congenital muscular dystrophy, 223–24 defined, 220–21 distinguishing, 223–24 Duchenne muscular dystrophy, 220, 221 research on, 225–27 spinal muscular atrophy, 220–21 treatment of, 227–36 NICU respiratory therapists, 44 Noncyanotic heart disease, 198–202 atrial septal defect, 198–200, 204–5, 214 characteristics of, 204–7 coarctation of the aorta, 201–2, 206–7, 215–16 9/28/09 11:57:05 AM 258 Index Noncyanotic heart disease (Cont.) patent ductus arteriosus, 200–201, 206, 215 ventricular septal defect, 200, 205–6, 214–15 Noninvasive positive pressure ventilation (NIPPV), 71, 226, 236 Nonsteroidal anti-inflammatory medications, for chronic lung disease of the newborn, 98, 99 Nutritional support for chronic lung disease of the newborn, 93, 98–100 for cystic fibrosis, 108 O Ostium primum defect, 205 Ostium secundum defect, 205 Oxygen, 20 for air leak syndromes, 178 bias flow, 20 blenders, 20, 178 mean airway pressure, 20 therapy, 69, 92, 93 P Palivizumab See Synagis Pancreatic enzyme replacement therapy, 114 Pancreatitis, cystic fibrosis versus, 107 Parainfluenza, 134 Parainfluenza virus, 137 Paramyxovirus, 134 Partial liquid ventilation (PLV), 14, 30–32 Patent ductus arteriosus (PDA), 200–201 characteristics of, 206 symptoms of, 206 treatment of, 215 Pediatric mask, 76 Pediatric nasal cannula, 94 Pediatric nonrebreather mask, 71 Pentamidine, 116 Percussor manual, 230 mechanical, 230 Perfluorocarbon liquid, 30 Pericarditis, 208–9 Perinatal asphyxia, 44 Persistent pulmonary hypertension of the newborn (PPHN), 22, 38, 40, 45 transition, 43 treatment for, 52 5467 Book.indb 258 Pharmacology strategy, for chronic lung disease of the newborn, 93, 97–98 antibiotics, 98 corticosteroids, 98 diuretics, 98 nonsteroidal anti-inflammatory medications, 98 short-acting bronchodilators, 97–98 Physical conditions, asthma and, 83 Pierre Robin syndrome, 46 Pneumomediastinum, 153, 161 characteristics of, 159 treatment for, 163 Pneumopericardium, 154, 161 characteristics of, 159–60 treatment for, 163 Pneumothorax, 151–52 case study, 156–59 characteristics of, 154–55 ongoing assessments for, 157 signs of symptoms of, 156 spontaneous, 151, 152, 161 tension, 151–52, 161 treatment for, 163 Positive end-expiratory airway pressure (PEEP), 2, 10, 11, 14, 15, 17, 40, 154, 172 Positive expiratory pressure (PEP), 110, 111 Positive inspiratory pressure (PIP), 154 Positive pressure ventilation, for upper airway inflammatory diseases, 127, 129 Power, in ventilation, 21, 179 Pressure control ventilation (PCV), 14 Pressure support ventilation (PSV), 97 Prone patient positioning, 26–28 contraindication for, 28 patient placement, 27–28 preparing patient for, 27 Prone positioning, 14 Prostaglandin E, 212 Pseudomonas aeruginosa, 107, 108 Pulmicort See Budesonide Pulmonary air embolism, 151 Pulmonary interstitial emphysema (PIE), 151, 154, 161–62, 163 characteristics of, 160–61 treatment for, 164 Pulmonary vascular resistance (PVR), 40 Pulmozyme, 107, 115 R Racemic epinephrine, 129 for bronchiolitis, 140 9/28/09 11:57:05 AM Research on acute respiratory distress syndrome, 8–13 on air leak syndromes, 162–63 on asthma, 63–69 on bronchiolitis, 137–38, 138–46 on chronic lung disease of the newborn, 90–92 on congenital heart disease, 209–10 on cystic fibrosis, 107–9 on infant respiratory distress syndrome, 46–48 on neuromuscular diseases, 225–27 on upper airway inflammatory diseases, 123–26 Respiratory distress syndrome (RDS), 39, 88–89, 151 conditions affecting, 45 treatment, 51 Respiratory syncytial virus (RSV), 89, 123, 134, 137, 138 Respiratory therapist, acute respiratory distress response and, 5–8 Respiratory therapy, for cystic fibrosis, 109–13 Respiratory treatment, for cystic fibrosis, 114–16 Rhinovirus, 134 Ribavirin, 142–43 S Servo 300, 82 Servo i, 82 Short-acting beta -agonist (SABA), 72, 75 continuous nebulizer therapy with, 75–77 Sinusitis, cystic fibrosis versus, 106 Sinus venosus defect, 205 Small particle aerosol generator (SPAG), 142, 143 Small volume nebulizer (SVN), for bronchiolitis, 141 Spinal muscular atrophy (SMA), 220–21 characteristics of, 221–22 Duchenne muscular dystrophy versus, 224 phenotype, 223 treatment of, 227–36 Spiriva, 115 Spontaneous pneumothorax, 151, 152, 161 Staphylococcus aureus, 209 Steeple sign, 123, 124 Steroid therapy, for croup, 123 Streptococcus pneumoniae, 209 5467 Book.indb 259 Index 259 Subcutaneous emphysema, 151 Suction, 22 Surfactant replacement therapy (SRT), 12, 48, 51 Synagis, 139 T Tension pneumothorax, 151–52, 161 Tetralogy of Fallot, 191, 192 characteristics of, 202 symptoms of, 202–3 treatment of, 211 Tidal volumes, 15, 165 Tobramycin, 116 Total anomalous pulmonary venous return (TAPVR), 195, 198, 199 characteristics of, 204 symptoms of, 204 treatment of, 213–14 Tracheal deviation, 155 Tracheoesophageal fistula, 46 Tracheostomy collar, 95 Transient tachypnea of the newborn (TTN), 38, 39, 42, 45, 151 risk factors for, 39 treatment for, 52 Transillumination, 155 Transposition of the great vessels (TGV), 191–95, 196 characteristics of, 203 symptoms of, 203 treatment of, 211–12 Treatment for acute respiratory distress syndrome, 13–32 for air leak syndromes, 163–83 for asthma, 69–83 for chronic lung disease of the newborn, 92–100 for congenital diaphragmatic hernia, 52 for congenital heart disease, 211–16 for cystic fibrosis, 109–16 for infant respiratory distress syndrome, 48–51 for meconium aspiration syndrome, 52 for neuromuscular diseases, 227–36 for persistent pulmonary hypertension of the newborn, 52 for transient tachypnea of the newborn, 52 for upper airway inflammatory diseases, 126–29 9/28/09 11:57:06 AM 260 Index Tricuspid atresia, 195, 197 characteristics of, 203–4 symptoms of, 204 treatment of, 212–13 Troubleshooting high-frequency jet ventilation, 173–74 high-frequency oscillator ventilation (HFOV), 181–83 U Upper airway inflammatory diseases, 119–31 bronchiolitis, 123 characteristics of, 120–22 croup, 120 defined, 120 epiglottitis, 120 foreign-body airway obstruction, 122 research on, 123–26 treatment for, 126–29 U.S National Library of Medicine, 38 Uterine shunt closures, 190 V Vapotherm device, 49, 50, 96 Ventilation, 20–22 for air leak syndromes, 178–79, 183 conventional, 164, 175 frequency, 20–21, 178–79 inspiratory time, 21, 179 5467 Book.indb 260 mechanical, 32, 144–46 power, 21, 179 Ventilator and oxygen strategy, for chronic lung disease of the newborn, 92, 96–97 Ventilator management, 96–97 Ventilators for air leak syndromes, 164 conventional, with iNO, 24 mechanical, 83, 93 Ventricular septal defect (VSD), 191, 194, 200 characteristics of, 205 symptoms of, 205–6 treatment of, 214–15 Vibratory devices, 110 Virazole See Ribavirin Vital signs, acute respiratory distress syndrome and, Vocal cord dysfunction, asthma and, 62 Volume guarantee (VG), 97 W Werdnig-Hoffman disease, 45, 222 Wohlfart-Kugelberg-Welander syndrome, 222 X Xopenex, 114 for bronchiolitis, 139–40 9/28/09 11:57:06 AM Credits Chapter 1-2 Courtesy of © Dräger Medical AG & Co KG, Lübeck, Germany; 1-3 Courtesy of CareFusion, Yorba Linda, California; 1-4 Courtesy of Bunnell Incorporated; 1-6 Modified from a photo courtesy of CareFusion, Yorba Linda, California; 1-8 Courtesy of Jessica Hopkins, University of the District of Columbia, College of Arts and Science, Studio Art; 1-9 Courtesy of Elgloria Harrison, University of the District of Columbia Chapter 2-1 Courtesy of Elgloria Harrison, University of the District of Columbia; 2-2 Courtesy of Vapotherm, Inc Chapter 3-2, 3-3, 3-4 Adapted from: National Asthma Education and Prevention Program Expert Panel Report 3, Guidelines for the Diagnosis and Management of Asthma US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication Number 08-5846, October, 2007; 3-5 Courtesy of Elgloria Harrison, University of the District of Columbia; 3-6 Courtesy of Philips Respironics, Murrysville, PA; 3-7 Adapted from: National Asthma Education and Prevention Program Expert Panel Report 3, Guidelines for the Diagnosis and Management of Asthma 55461_ch13_CRED_5467.indd 261 US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication Number 08-5846, October, 2007; 3-8 Courtesy of CareFusion Corporation or one of its subsidiaries; 3-9 Courtesy of Monaghan Medical Corporation; 3-10, 3-11 Courtesy of Elgloria Harrison, University of the District of Columbia; 3-12 Courtesy of Westmed, Inc.; 3-13 Courtesy of CareFusion Corporation or one of its subsidiaries Chapter 4-1, 4-2, 4-3, 4-4 Courtesy of Elgloria Harrison, University of the District of Columbia Chapter 5-1 The Vest ® Airway Clearance System is a registered trademark of Hill-Rom Services, Inc © 2009 Hill-Rom Services, Inc REPRINTED WITH PERMISSION-ALL RIGHTS RESERVED; 5-2 Courtesy of Axcan Pharma Inc.; 5-3, 5-4 Courtesy of Smiths Medical; 5-5 Courtesy of Percussionaire Corporation Chapter 6-1 Courtesy of David Paulk, Arcadia University; 6-2 Courtesy of Hugh Dainer, MD, PhD; 6-3 Courtesy of Nova Health Systems, Inc.; 6-4A, 6-4B Courtesy of Elgloria Harrison, University of the District of Columbia 9/28/09 12:00:05 PM 262 Credits Chapter Chapter 10 7-1 Courtesy of Elgloria Harrison, University of the District of Columbia; 7-2, 7-3 © Jones and Bartlett Publishers Courtesy of MIEMSS; 7-4 Courtesy of Elgloria Harrison, University of the District of Columbia; 7-5 Courtesy of Valeant Pharmaceuticals; 7-6 Courtesy of Jessica Hopkins, University of the District of Columbia, College of Arts and Science, Studio Art 10-1 The Vest ® Airway Clearance System is a registered trademark of Hill-Rom Services, Inc © 2009 Hill-Rom Services, Inc REPRINTED WITH PERMISSION-ALL RIGHTS RESERVED; 10-2A Courtesy of General Physiotherapy, Inc.; 10-3 Courtesy of Jessica Hopkins, University of the District of Columbia, College of Arts and Science, Studio Art; 10-4 Courtesy of Percussionaire Corporation; 10-5 Courtesy of Philips Respironics, Murrysville, PA; 10-2B Courtesy of Smiths Medical; 10-2C © 1999 KimberlyClark Worldwide, Inc Used with permission Chapter 8-4, 8-5 Courtesy of Elgloria Harrison, University of the District of Columbia; 8-7, 8-8, 8-9 Courtesy of Bunnell Incorporated; 8-10 Courtesy of Elgloria Harrison, University of the District of Columbia; 8-T03 Courtesy of Bunnell Incorporated; 8-11, 8-12 Courtesy of CareFusion, Yorba Linda, California Unless otherwise indicated, all photographs and illustrations are under copyright of Jones and Bartlett Publishers, LLC Chapter 9-1, 9-2, 9-3, 9-4, 9-5, 9-6, 9-7 Courtesy of Jessica Hopkins, University of the District of Columbia, College of Arts and Science, Studio Art 5467 Book.indb 262 9/28/09 11:57:06 AM ... Elgloria A Neonatal respiratory care handbook / Elgloria A Harrison p ; cm Includes bibliographical references and index ISBN 978-0-7637-5546-1 Respiratory insufficiency in children—Handbooks,... available on the subject of neonatal and pediatric respiratory care As I continued to reflect on the everyday job of a respiratory therapist in a neonatal intensive care unit (NICU) or a pediatric...55461_FMXx_ttlpg.indd Neonatal Respiratory Care Handbook Elgloria A Harrison, MS, RRT-NPS Associate Professor Department of Nursing and Allied Health Respiratory Therapy Program University