High Flow

I guess it helped that I said things were going to be slow for awhile, because today was not at all a slow day! So lets start with the basics. Her weight today was 3lb 6.6oz. She had her ROP eye exam today and she is still showing no signs of disease, which is fantastic. When the RT came in this morning he was asking me if they had talked about extubation because Penelope's vent settings were so low that the machine wasn't really doing anything. To top it off she was sitting at 22% oxygen, regular air is 21%. I told him that they had mentioned it yesterday, but I didn't know what their plans were yet. On rounds Dr M surprised all of us by suggesting that we skip past CPAP and go straight to high flow nasal cannula. I couldn't believe it! He's not the sort of person who likes to skip steps even if they seem warranted. So a nasal cannula is a tube with two little prongs that go into the nostril. It's what you typically see on people who are receiving oxygen supplementation. 'High Flow' means that the oxygen blend is pressurized. She is on a flow of 3 liters per minute (it can go up to 6). For most of the day she sat at 21% oxygen, the lowest setting there is.

So if her settings are so low why does she need a nasal cannula?  1) Preemies are not good a storing oxygen, so when she moves a lot she de-saturates (de-sat), meaning she uses up whatever oxygen reserve she had . So when she de-sats they can increase her oxygen to help her build back up her stores more quickly. 2) Preemies are not good at taking deep breaths. The high pressure forces her to take deeper breaths than she would on her own. Deeper breaths mean better saturation.

As a result of all the chaos today she was pretty crabby. I tried holding her this afternoon but it was too much for her. So I only got to hold her for about 15 minutes and she spent the majority of the time clawing at me. So hopefully tomorrow she will be in a better mood and I will get to hold her more.