A neonate delivered at 32 weeks, is put on a ventilator, X-ray shows 'white out lung' and ABG reveals P02 of 75. Ventilator settings are an, FiO2 of 70, and rate of 50/minute. Next step to be taken should be?

Ans. is 'c' i.e., Continue ventilation with the same settings Lets see the individual findings. The neonate is premature. X - Ray shows 'White - Out' : is a sign of Hyaline Membrane disease in the Newborn i.e. RDS. ABG reveals p0, of 75 : which is acceptable. Fi02 : Fractional Inspiratory 02, here in the ventilator settings, is 75% well above the normal. Respiratory Rate settings in the ventilator is 50/min : Normal for that age. Now, we have the complete picture here : The premature baby is having HMD, and so has been put on Aificial respiration. The Fi02 being given is in the higher normal range, and also the paial pressure of 0, in the neonates blood is acceptable . So we will avoid increasing the Fi0,, as this carries a risk of blindness by ROP (Retinopathy of Prematurity). As a rule, we avoid tampering with the ventilator rate settings, because it causes changes in the CO, levels of the blood, and consequent disturbances in the acid - base balance. This is also one of the reasons for keeping this rate of 50/min. in this neonate. Weaning from ventilator will sta once the baby shows hyper - oxygenation with the currect settings, i.e. the p02 in the range of 120 . The answer here would be to continue the current settings till such time when the baby shows hyper-oxygenation, and then slowly wean him off the ventilator