VentWorld Case Studies

Published July 27, 2000

William French and John Raber
Lakeland Community College, Kirtland, OH

Contents (click to jump directly to that section, or scroll down to read the case)


Baby C was a 31 week male neonate born vaginally to a 36 year old mother. Birth weight was 1200 grams. The baby presented with meconium in the oropharynx.


Baby C was immediately intubated and suctioned for a large amount of meconium. After suction, the baby was given 100% oxygen and his respirations were supported. His 5 minute Apgar score was 5, with acrocyanosis and grunting respirations. L/S ratio was 1.5:1

Once he was stable, he was extubated and placed in a oxyhood with 30% oxygen. After an hour, his clinical status deteriorated with increasing respiratory distress noted. An arterial blood gas revealed the following

pH 7.31 PaO2 46 mmHg
PaCO2 42 mmHg SaO2 78%
HCO3 18 mEq/L FIO2 0.30 (oxyhood)

An hour later, his clinical status continued to deteriorate, with a Silverman score of 10. Heart rate was 160 beats/minute, respiratory rate was 72 breaths/minute with audible expiratory grunting. Arterial blood pressure was 52/29 mmHg.

At this point he was placed on CPAP at 6 cmH2O and 80% oxygen. ABGs taken after 30 minutes were:

pH 7.25 PaO2 44 mmHg
PaCO2 50 mmHg SaO2 77%
HCO3 21 mEq/L FIO2 0.80

Immediately after these ABGs were analyzed and reported, the baby was placed on positive pressure ventilatory support using the Galileo ventilator. Settings were: IMV mode, respiratory rate 40 breaths/minute, peak inspiratory pressure (PIP) 20 cmH2O, PEEP 4 cmH2O, FiO2 80%. Two hours later he was given 4.8 mL of Survanta (dose: 4mL/Kg). His condition improved over the next several hours and within 12 hours after initiation of ventilatory support his FiO2 was weaned down to 40%.

His condition continued to improve with no additional complications, and he was discharged four weeks postpartum. Upon discharge he weighed 2000 grams.


What might have caused the episode? Do you think the staff recognized and managed the case appropriately? Post your thoughts or ask other questions related to this case.

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