Recent discussions
-
Виктория Антонова
I thank CoSTR for attempting to wrap our heads around how to approach a non-vigorous infant that is meconium-stained. HOWEVER, what we fail to do in each individual case is to assess the degree of meconium airway obstruction on first glance, that needs to be overcome quickly to proceed with air exchange. How is that done ? Only by direct laryngoscopy and suctioning if necessary, by a skilled and efficient intubator ! Since the only people well-trained enough are skilled practitioners( MD, RN, RRT'S) that are familiar and efficient at quick intubations, we are left making separate recommendations for those of us who can get in and out before delaying precious time to get air exchange going, and those of us who are not that efficient. I have struggled with how to approach this in the best way to be fair to both, but must admit there is none. If you need to ventilate, even though you are blowing meconium down an airway, I must accept the fact that this will cause much less CNS damage and morbidity in the long run than making less-skilled intubators struggle with clearing an airway for the best respiratory outcome - am I making sense ? -
Виктория Антонова
It is good to see increasing evidence steering us away from a historical practice that delays definitive management of the airway of infants who predominantly have low tone rather than any form of obstruction. Opening the airway through good non-invasive techniques or with adjuncts (including ETT where necessary) is the key to improving outcome. Delay in this, from whatever route, has the potential to be to the detriment of the infant. In the rare event of airway obstruction this will rapidly become apparent from initial manouevres and direct visualization and more advanced airway techniques can be instituted at this point. -
Виктория Антонова
Agree with the authors. Tracheal suctioning delays resuscitation in the babies that needs it the most. -
Виктория Антонова
I think that a once suction with laringoscopy before resuscitation provide a better ventilation. -
Виктория Антонова
Eu concordo com as recomendações atuais do Ilcor -
Виктория Антонова
Appreciate the lack of large enough studies to make stronger recommendations. Urgent need for a multicenter RCT to inform "best practices". Until then I suggest (for non-vigorous babies with meconium staining) "One endotracheal suction attempt to clear particulate meconium, then ventilatory support as needed". -
Виктория Антонова
Concordo com tudo, não acho necessário nenhuma alteração -
Виктория Антонова
The routine suctioning of non-vigorous infants after meconium aspiration can be perfomed once and both, tracheal suction and intubation must be a priority in these cases . The same like Rita. -
Виктория Антонова
Agree that the wording and recommendations appear to be an accurate reflection of the current state of evidence. Well done. -
Виктория Антонова
I belive that trachea aspiration of the newborn that is born bathed in meconium liquid and not vigorous, should be performed. After not responding to Positive Preassure Ventilation with mask and there is need to be intubated for better ventilation of the lungs