Preemies & Respiratory Equipment in the NICUFriday, February 22, 2008 2:26
The NICU is a confusing place, with a dizzying array of equipment which helps keep the tiniest warriors alive. One thing that many preemies have in common is having immature lungs which haven’t developed well enough to allow them to breathe on their own. There are many different types of devices that can be used to help your baby breathe, depending on how immature their lungs are. We’ll explain the most common of these devices below.
Babies with the most immature lungs need help taking a breath, because they lack both the chemical surfactant and lung structure they would normally have at term. These babies are usually put on a ventilator (vent) to help them move air in and out of their bodies, and while on the ventilator, they are usually given artificial surfactant to help the small air sacs in the lungs (alveoli) expand. When a baby is placed on a ventilator, an endotracheal (ET) tube is inserted into the baby’s airway, through their mouth, and this tube is connected to the vent. A typical ventilator uses positive pressure to inflate the lungs and deliver oxygen. With this type of ventilator, doctors can control a baby’s breathing rate and volume, the pressure used to inflate the lungs, and the amount of extra oxygen given. The problem is, with this type of ventilator, the pressure used to open up the lungs can cause damage over time, leading to scarring in the lungs, and sometimes life long respiratory problems.
High Frequency Ventilators
Because of the potential for damage caused by positive pressure ventilation, the sickest and tiniest babies and those who are no longer responding well to traditional ventilators are sometimes put on high frequency ventilators. These ventilators come in four types, but the one most frequently used in the NICU is the high frequency oscillatory ventilator, otherwise known as an oscillator. An oscillator uses a very high respiratory rate, typically between 120 and 480 breaths per minute, to move very small volumes of air. Babies on an oscillator appear to be vibrating from this rapid movement of air.
If a baby is stronger, and their lungs are more developed, Nasal continuous positive airway pressure (CPAP or N-CPAP) can be used to help them breathe. This device may be familiar if you know an adult with sleep apnea. With CPAP, large plastic prongs are inserted into a baby’s nose to provide continuously pressurized air and oxygen to the airways. These tubes fit tighter into the nostrils than those used in a nasal cannula. Using CPAP keeps the lungs partially inflated between breaths, making breathing less work.
Sometimes a baby in the NICU only needs a little extra oxygen or humidified air to help them breathe for a short time. In these cases, an oxyhood, which is a clear plastic hood that is placed over a baby’s head can be used to provide moist air with or without extra oxygen.
Babies that are strong enough to breathe on their own without getting tired, can also be given extra oxygen through small rubber tubes placed in the nose, called nasal cannula. Babies who are doing well otherwise, can leave the hospital on a nasal cannula attached to a portable oxygen tank. Some preemies continue to receive oxygen this way throughout their first year or beyond.
These machines are just a few of the tools that NICU staff and respiratory therapists can use to help your preemie breathe. I’ll follow up with information about respiratory medications, chronic lung disease and apnea of prematurity in a later post.