Mechanical Ventilation Strategies.The Egyptian Consensus on the Management of Neonatal Respiratory Distress Syndrome 2017

NEONATAL CARE NETWORK 2017 (NCN

Recommendations

1.After stabilization, MV should be used in babies with RDS when other methods of respiratory support have failed (A1). Duration of MV should be minimized (B2).

2.Targeted tidal volume ventilation should be employed as this shortens the duration of ventilation and reduces BPD and intraventricular haemorrhage (A1).

3.HFOV may be useful as a rescue therapy (B).

4.Avoid hypocarbia (A1) as well as severe hypercarbia (C2) as these are associated with an increased risk of brain injury. When weaning from MV, it is reasonable to tolerate a modest degree of hypercarbia, provided the pH remains above 7.22 (B2).

5.Caffeine should be used to facilitate weaning from MV (A1). Early caffeine should be considered for all babies at high risk of needing MV, such as those <1,250 g birth weight, who are managed on non-invasive respiratory support (C1).

6.A short tapering course of low-dose dexamethasone should be considered to facilitate extubation in babies who remain on MV after 1–2 weeks (A2).

7.Inhaled steroids can be used to reduce BPD.

  • Qual­i­ty of evi­dence
   – High qual­i­ty A    – Mod­er­ate qual­i­ty B    – Low qual­i­ty C    – Very low qual­i­ty D MODIFIED FROM: Euro­pean Con­sen­sus Guide­lines on the Man­age­ment of Res­pi­ra­to­ry Dis­tress Syn­drome – 2016 Update Spon­sored by: abb­vie EGYPT Shar­ing pro­fes­sors:
  • Prof Abdel Rah­man El Mashad (Tan­ta univ)
  • Prof Afaf Kor­raa (Azhar univ)
  • Prof El Sayed Kha­laf (Port fouad hosp, min­istry of health)
  • Prof Iman Eskan­der (Cairo univ)
  • Prof Hes­ham Abdel Hady (Man­soura univ)
  • Prof Hes­ham Ghaz­al (Alexan­dria univ)
  • Prof Mag­da Badawy (Cairo univ)
  • Prof Madi­ha Abdal­la (Minia univ)
  • Prof Magdy Kamel (Minia univ)
  • Prof M Abdel Aaal El Bagy (Sohag univ)
  • Prof Morad El Alfy (Al Galaa mil­i­tary cen­ter)
  • Prof Nahed Fah­my (Cairo univ)
  • Prof Nay­era Ismaeil (Ain Shams univ)
  • Prof Raguia Atwa (Ain Shams univ)
  • Prof Safaa Shafeek (Ain Shams univ)
  • Prof Sozan Gad (Suez canal univ)
  • Prof Osama Hus­sein (Port said neona­tol­ogy soci­ety)
  • Prof Osama Kasem (Al Galaa mil­i­tary cen­ter)
  • Prof Yehia Mah­moud Basha (Daman­hour teach­ing hosp)
  • Prof Zahraa Ezz El Deen (Cairo univ)