Neonatal Respiratory Physiotherapy. Nicky Hawkes Advanced Respiratory Physiotherapist Oct 2011
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1 Neonatal Respiratory Physiotherapy Nicky Hawkes Advanced Respiratory Physiotherapist Oct 2011
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3 Respiratory Physiotherapy?..Not just percussion! Assessment of baby s respiratory status and deciding what are the presenting problems How to address the issues Treatment options Respiratory management current and ongoing Part of the MDT The wider picture Developing the service Advancing practice
4 Neonatal Toolkit 2009 All units caring for babies requiring intensive care and providing a chest clearance service have access to a paediatric respiratory physiotherapist with experience in assessing and treating premature and sick newborn babies Access to education and training is available to enable members of the MDT to be trained to the level of competence necessary to enable the delivery of high quality care Bliss Baby Charter 2009 Staff adopt a multidisciplinary approach to care that draws on generalist and specialist neonatal health professionals Criteria: Timely access to allied health professionals
5 National Institute for Health and Clinical Excellence 2010 Quality Standards Topic: Specialist Neonatal Care Quality Statement 3 Specialist services have a sufficient, skilled and competent multidisciplinary workforce Evidence of local arrangements to provide a multidisciplinary service trained and competent in the care of neonates that has access to: Specialised neonatal physiotherapists (Dieticians, OTS, SALTs)
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7 Previous practice Variable reputation Routine With cares - frequent Masks No guidance regarding examination/clinical reasoning/practical skills Indications v contraindications Staff had not received recent raining No chance to step back and review/develop practice ANNP dissertation
8 Indications: Secretion issues: Secretion tenacity Percussion Acute collapse due to mucous plugging Pneumonia Aspiration Increases expiratory flow and muco- ciliary transport Contra-indications Prolonged clotting platelet levels <50 Recent IVH Pulmonary haemorrhage Fractures/severe osteopenia Severe instability < 26/40 within first week of life Cautions Skin integrity Platelets
9 Cotside teaching Clinical picture Examination Developmental care Clinical reasoning Treating the baby together Auscultation/positioning/suction/percussion Supervising, encouraging & suggestions Post intervention examination Advice Agreed treatment plan Records/liaison
10 Positioning
11 Secretion clearance Strategies? Support through treatment?
12 Hazards: Hypoxaemia Atelectasis Bradycardias Trauma Cardiovascular disturbance Suction Good technique: Mully tip catheters Controlled pressures Care with depth of suction Pre-oxygenation/manual breaths Saline as indicated Good developmental care support Closed suction for oscillated babies/nitric
13 Extubated babies Chronic lung disease Neurological problems
14 Surgical babies - PICU Full Physio cover Post op - thick secretions segmental/lobar lung collapse Potential instability and unpredictability Desaturations Bradycardia Distended abdomen static position and problems with turning New stomas/wounds/drains Sepsis coagulopathic restrictions using percussion
15 Reduced intubation rates for infants after the introduction of high flow nasal prong oxygen delivery A.Schliber et al Intensive Care Med : 298 infants In the subgroup viral bronchilolitis, rate of intubation was reduced to 7% compared to 37% Humidified high flow nasal cannulae: Current practice Australasian nurseries; a survey J L Hough et al 2011 Widely used Optiflow over Vapotherm 4-6 litres, not >6l in infants <1 kg Comfort & tolerance Problems rainout,, nasal prong fixation & occlusion of flow Concerns re evidence, actual CPAP levels produced with higher flows, guidelines use & weaning
16 What s the evidence?
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18 Education/promotion of role NNUs Talks Scenario based Skills drills University courses Physiotherapy study days/out of hours training Considering new formats DVD/interactive National projects Conferences and national courses Professional development
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Effectiveness of Manual Hyperinflation Therapy plus Postural Drainage and Suctioning To Prevent Ventilator Associated Complications Sumbla A 1, Rafaqat A 2, Shaukat A 3, Kanwal R 4, Janjua UI 5 Abstract:
Intubation sedation intubation
Intubation sedation Mar 29, 2017. When a paralytic agent is used for intubation without sedation, the patient may be fully aware of his or. Oct 11, 2016. This post will review sedation and analgesia regimens