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I was wondering if anyone is using the RAM nasal cannula in NIV on neonates or peds? Specifically with the Babylog VN500. If so, are you having success?
Thanks!
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We do, as an evaluation, but not with the VN500. The principal stay the same (I think...), and to be honest it's not wokting very well. It's basicaly a HFNC with pressure limitation. Because of the lenght of the tubing (the canula) and the diameter of this one to, I think there is a lost of pressure. So far, it's working well on the BPD who where on CPAP +4 or +5 ,FiO2 21-,23...
:-)
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Does the device you are using have adjustable flow? How much flow do you typically run?
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Yes it is. The cie recomendation is to start with 12L/min. I agree that it's quit high, but it's presure target. So I ask biomed technicien to come...
with the machine flow mesurement (biomed) it was calculate that it will not given flow higher then 9L/min on NIV biphasic with medium prong with this settigns: 15/5. But... there is some study on HFNC (see Pubmed)who shows that a flow grader then 5L/min may be wrong on small baby if nare occlude by secretion and mouth maintain close.
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We have had great success with our trial thus far. For the trial we use the RAM with bubble CPAP and NIPPV. We use the XL ventilator and have only had one patient on NIPPV since the trial started. We have access to test results by a neonatologist and a respiratory therapist. The testing was done on an ASL 5000 lung model. The set pressures with bubble CPAP as well as in NIPPV were the same pressures measured in the lung model. This is a little reassuring that the pressures we intend to deliver are close or the same. I don't think we will have more solid evidence unless people are willing to start testing neonates. This may be a question for Geof Lear or anyone else who may know the answer. We use the XL ventilator and only have the autoflow option in the neonatal category. Our understanding is the XL will deliver whatever flow is required to deliver the set pressures (up to 30 lpm). Also, does the basic flow work in NIV and what effect does it have on flow delivery? The RAM is intended to be used with a leak, and I know the XL will compensate up to a 7 lpm leak. We have not had enough experience with the RAM and NIPPV thus far, so I can't comment on how it performs through the Drager at this point. Edited by user Thursday, May 17, 2012 12:58:36 PM(UTC)
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I just tested the base flow on the XL and it is present in NIV in the neonatal range, not in ped or adult. I believe the 7 liters of leak compensation is for triggering purposes and of course without the neoflow sensor there is no trigger. The XL also has NIV+ available as an enhancement that supposedly will raise the leak compensation to the full 30 lpm. I ran a very basic test trying to see how high the flow would respond by using the flow sensor on a different vent but it would only show me flow up to ~5 lpm but I know it was delivering a lot more flow based on the audible flow (I could open the leak to where the flow sensor measured 5 lpm and then keep opening it and audible increased but flow measurement did not). I believe there are still some questions about disconnection alarms as RAM wants a substantial leak and you have to balance the desired leak versus a true disconnection.
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We use the RAM cannula and the VN500 ventilator and we have had great sucess. We use the Draeger in Non innvasive mode with no flow sensor. PC-CMV for NIPPV. We use PEEP's anywhere from 5-9 and pip anywhere from 15-28 with RR of anywhere from 10-30. We are pretty agressive with NIPPV and the Ram and have had great sucess. We use a lot of bubble cpap not to tie up vents with cpap patients as well.
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 1 user thanked lisa.pappas for this useful post.
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damian.solorzano on 9/24/2013(UTC)
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