Thank you so much! You’re so encouraging! We bet you’re great to work with :)

Congratulations on finding the best field Fougler! We are SO happy these are helpful. Thank you so much for subscribing and for taking the time to comment :)

Oh I LOVE that! In Arabic it means a 'little palm tree' so I think I prefer the Persian translation! ha! (Although a viewer from the Philippines told us it also means 'star'! ha!) Honestly though- this has been a massive team effort- we all collaborate on the videos, and Arianna spends HOURS making them more understandable!! Ha! Thanks so much for being here :)

Oh congratulations on your residency! We have jets down on our list- we promise we'll get around to it when we finish our cardiac series :) Thank you so much for being here!

That's fantastic Britney-thanks for letting us know :) We are definitely planning another lecture on the jet (relatively soon)-and more gas lectures too. Good luck on your studies!!

Thank you so much Shija, for taking the time to send us this lovely comment. Messages like yours definitely make us want to keep going :)

Thanks Chris for your comment! You're absolutely right the power is what determines the delta P and the actual setting that needs to be adjusted- but I'm guessing you come from the RT side of things- as in every NICU I've worked in, the order we place is always for delta P or amplitude. Thankfully, the NICU RTs are always are of this. And I agree- any ventilator in the wrong hands- just like any machine- is dangerous. Thanks!

I wish I could!!! Ha!!! There’s a lot with the machine I don’t know how to trouble shoot or work. What is it specifically you’d like? A good friend is an RT and he’s willing to do videos!!!

Thank you so much Dr. Asefa. I can't tell you how happy that makes us. It is a super-complex topic, and I'm sure there are hard core mathematicians out there who would be disappointed I didn't go deeper into the different mechanisms of gas exchange and the physics behind it all! I've never heard of Med Ed on the Go- is it a similar format? It's so great there are all these amazing resources now for learning. We are planning a video on the jet soon (the same type of video as the oscillator ones). But for the different modes on the conventional ventilators, I'd love to be able to do that bedside, on an actual vent. It would be much easier for everyone to understand, I think, if they saw it live. We're figuring out how to do that without breaking any hospital rules etc!. (In the meantime- the vent lecture part 2- gives some basics on conventional vents. This is probably already pretty basic for you though). Thanks again for writing to us and for watching!!

Oh Carolyn that makes us so happy! Thanks! We haven't done TPN and electrolytes yet (SO massive- but we have to get around to it!). Chest tubes we're tying to work out how would be helpful without a baby (we need a sim toy I think!). And what does RAAS stand for? sorry not sure what that acronym is! Thanks for being here- we're so glad we're of some help :)

Oooo me too! I am in nnp school!These videos are awesome

@@TalaTalksNICU renin-angiotensin-aldosterone system (RAAS)

Yes of course!!!! That is a GREAT idea too- thank you!

Thank you so much for watching and taking the time to comment!

Thank you so much for your presence on this channel! We love all your motivating comments :)

Hi Katarina! Thanks so much for your lovely words and suggestions :) Those are all excellent subjects. We are starting with NEC this week- but we will plan on all the others too. Thanks for being here!

Hello! Great question!!! I’m just going to speak for myself here (Tala)- Arianna and Justin may think differently. Generally- I try to avoid every single medicine that I don’t think is definitely needed. Once we start sedatives/ pain meds on high frequency- we’re probably not going to stop them any time soon-so if it’s a 22-23 weeker then that could be a few weeks on the meds. Especially- since every few years- we worry about the effect of a specific med on development. Also apparently, adults on the oscillator- specifically- have likened it to getting a massage. I don’t know if this is true! But some babies can look very comfortable on the machines. Having said all of this- if the bedside nurse tells me once the baby looks uncomfortable- I’ll write for anything! Not sure if that’s helpful?!!!

And definitely not paralytics - unless that’s literally only way to keep baby alive. Paralytics end up with the baby retaining water and collapsing areas of the lungs- so may be helpful short term but then you’re in a worse state. Sometimes - sedation does help the machine do its job- so here again- would use it (eg bad pulm HTN baby who we definitely don’t want agitated)

Oh so happy that it helped at all! Thanks for letting us know :)

Thank you so much- glad you think so

SO happy you found it clear. These are my favorite videos we've filmed (Tala) so I'm extra appreciative here!!!

Hello Jamie! we hadn't discussed this- but it's an excellent idea. I'm not sure what the NICU nursing certification involves? What resources do nurses usually use? Once we look over them we could tailor our videos more specifically to make sure we cover relevant topics. Any info would be so valuable! Thanks!!

Thank you so much Monjid! You have a lovely way of commenting :)

Thank you so much- we're so glad you found this helpful. Thanks for watching and for taking the time to let us know!

Thanks so much Cini, that is definitely our aim- practical information for the bedside. Thanks for watching and for letting us know!

So glad you think so Sanjay. Thanks so much for watching and commenting :)

We love all your comments Henry Pak! Thank you so much! We promise we are getting around to non-invasive forms of ventilation soon! Thank you for continuing to watch these :)

HI Bettina! These are excellent questions- and they're all super dependent on the patient and the unit0 (AND THE XRAYS- if you're super-inflated- doesn't matter how low your pressures are- you don't want to go higher)- but it's always nice to know how different units do stuff- so we'll make some suggestions! a) Max AC-PC- rate 40, pressures needed in 30s (or high 20s for preemies). Volume control- not getting there with Tv > 6ml/kg or needing super high pressures to get you tidal volumes b) Max values oscillator- really dependent on the Xrays- but have gone up to a mean of 30 and delta P of 50 in term sick kids (lower in preemies) c) Extubatable- you want to get as low as possible- especially with the mean- low teens for the oscillator, preferably. d) Generally you would change to pressure control if you had a large leak with the ETT (unable to accurately measure pressures)- or for whatever reason you're using much higher pressures than you'd feel comfortable with achieving the volumes. e) ALL the machines are completely different! And for whatever reason- some babies just hate a form of gas exchange over another. We'e definitely had those situations where we've tried the jet or the oscillator and a baby has hated both and we've gone back to a regular ventilator. Ultimately you want to be on the machine that can oxygenate and ventilation for the baby with the least support possible!!! Hope these vague answers help!!

Thank you so much- appreciate you being here and taking the time to comment- thank you

Wow! Thanks Naitram. We really appreciate you taking the time to comment :)

We're so glad you found it helpful Anita. Thanks so much for taking the time to comment!

Hello Griffin- thanks so much for watching this too. We touched on iNO in the PPHN video, but we can also discuss it more broadly as a medication. When else do e use it? In preemies? What dose? How do we wean? We can definitely get to that- thank you!!!!

Yes PN! This is a great idea- the problem is figuring out what would be the most helpful thing to do, given we can't show anything on a patient. We will try to find an adequate set up for a simulation. Thanks!!!

Thanks for watching!

YES! Thanks for mentioning this- we WANT the wiggle to extend to the umbilicus in babies. Thank you!

So glad you liked these- we loved choosing what information to include! Thank you!!!!

Yes! That's a great topic... although with the excellent improvement in nutrition in the last decade or so, we see bad osteopenia so much less. Thanks for a great suggestion!

HA! That's perfect!! Thanks!!!

Thanks so much Zia!

Thank YOU- for watching!

Excellent point- it’s weird because on the oscillator: decreasing the frequency actually recruits long volume- so it can help inflate the lungs. We often don’t use it this way- but we have when we’re desperate!

Dear Fairoos- at 23 weeks the lungs are so exceedingly immature that it doesn’t take a “cause” to need high settings and high oxygen. You have to wait it out while you concentrate on growth and be as gentle as possible. Sorry took time to get back!

YES! Will happen before end of year- I promise!!!!

NO! SORRY!!! Will be first one out in new year (when we’re releasing next NICU videos)

Hello! If you go to our home page we have a playlist on fluids and electrolytes- maybe start there. If there’s something else you’d like us to discuss we can cover it! Thanks for being here :)

Yes- we are definitely planning on this in the New Year. Thank you for watching and for taking the time to comment :)

Great question- we try to NEVER sedate a baby unless we really really have to. So unless baby is fighting the vent and not doing well we try not to. If baby looks comfortable we won’t give anything. (Like hopefully feels like a massage). Obviously we don’t want any baby fighting the vent and grimacing etc- so we’ll give meds if we have to!

Hello Jameson! We have all used NIPPV (non invasive positive pressure ventilation) a lot, and we have used NAVA in the past bot not frequently. Both are excellent suggestions for videos. Thanks so much!

Ha! Def not but appreciate the sentiment!!

Hello Michael! We have been going back and forth with representatives from the AAP (who are responsible for NRP)- and hopefully they are about to allow us to film a video on NRP and 8th edition updates. Stay tuned!!

Thanks so much for your continued support.

Generally we’re going on an oscillator because we need more help with oxygenation- so this helps that. But we consider it less damaging to provide this constant open pressure this way and so we can afford to give a higher MAP. I haven’t seen a study that compared the expansion at different means on different machines (and briefly tried looking)!!

@@TalaTalksNICU Thanks 🌹

I searched for that I found There is an open lung strategy of *- High volume lung strategy in which we add 2-4 to MAP and used in most conditions when the HFOV is the ventilatory support **- Low volume lung strategy in which we substract 2 from the MAP value It is recommended in patients with air leak syndromes

Great question- we've really reached the point in neonatology that the LESS we can do to babies- especially with medications etc- the better it will be for them. We don't know the full developmental effects of routinely giving narcotics or benzos etc. So- we wouldn't routinely sedate a baby unless it meant that it was really affecting oxygenation and ventilation. (Adults have said that being on an oscillator can feel like a massage). We try to never paralyze babies (unless for operations)- unless it's an absolute point of desperation. Generally, once they're paralyzed, they become more edematous, which worsens their respiratory status even further. So if you're trying to keep a. baby alive or off ECMO, then we can do this- otherwise, we really try to avoid it. Excellent questions- thank you!

Good question! The I: e ratio is usually set at 1:2 or 33%. We don't really change this!

Offff I’m sorry! I promised this ages ago- it’s half way written at least! We promise we’ll get it out soonish!!