Neonatal Resuscitation Beyond Advanced: Meconium Aspirator

Introduction

• Neonatal resuscitation includes essentials and advanced techniques.
• Focus on the use of the meconium aspirator, a tool specific to neonatology, for managing airway obstructions.
• The goal is understanding when and how to use it effectively.

The Nightmare Scenario

• Situation: Inability to ventilate a newborn due to airway obstruction.
• Team's unfamiliarity with the meconium aspirator can lead to delays.

How to Use the Meconium Aspirator

1. Intubate the Baby
   • Use an appropriately sized endotracheal tube.
2. Connect the Aspirator
   • Ensure it is attached to the suction source, set at 80-100 mmHg.
3. Suction Process
   • Attach the aspirator to the endotracheal tube.
   • Occlude the suction port with a finger to divert suction to the endotracheal tube.
   • Withdraw the tube slowly over 3-5 seconds while maintaining suction.
4. Post-Procedure
   • Be ready to resume face mask ventilation or reintubate if necessary.

When to Use the Meconium Aspirator

• Shift from routine suctioning of babies with meconium-stained fluid following the 7th edition NRP guidelines.
• Resuscitation principles are now the same regardless of fluid type.
• Use is indicated after unsuccessful attempts of ventilation and obstruction suspicion.

NRP Guidelines

• Routine Suctioning: Not recommended for any babies (crying, haptic, pink, noisy, or blue).
  • Unnecessary suction can reduce oxygen saturation and lower APGAR scores.
• Effective Ventilation: Use only if obstruction is suspected after failed ventilation attempts.

Troubleshooting with MR SOPA

• Approach for when PPV is ineffective:
  1. Check mask seal and reposition airway.
  2. Suction the open mouth with bulb or catheter.
  3. Increase pressure.
  4. Insert alternative airway (endotracheal tube) if needed.
  5. Use meconium aspirator if airway obstruction persists.

Versatility of the Meconium Aspirator

• Can clear thick secretions: meconium, cellular debris, vernix, blood, etc.
• Converts endotracheal tube to a large-bore suction catheter for any obstruction type.

Recap

• How to Use:
  1. Attach to suction at 80-100 mmHg.
  2. Attach to endotracheal tube.
  3. Occlude suction port and withdraw tube slowly.
• When to Use:
  • After all MR SOPA steps and if obstruction persists.

Conclusion

• Effective use of the meconium aspirator can significantly improve neonatal resuscitation outcomes.
• Follow guidelines and assess each situation carefully.

Engagement

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