Flow Inflating Bag

Overview 

In the neonatal care setting, Flow Inflating Bags (FIBs) emerge as crucial devices for providing respiratory support to newborns. 

Flow Inflating Bags represent specialized respiratory tools employed in neonatal care. These bags differ from self-inflating bags in that they necessitate a continuous gas flow to remain inflated. This unique design allows for precise control over ventilation parameters, making FIBs well-suited for the delicate respiratory needs of newborns. 

 Purpose in Neonatal Intensive Care Unit (NICU) 

The primary purpose of Flow Inflating Bags in the Neonatal Intensive Care Unit (NICU) is to deliver immediate and targeted respiratory support to newborns facing respiratory distress or requiring resuscitation. Specifically crafted for neonatal resuscitation scenarios, FIBs play a vital role in facilitating lung expansion, improving oxygenation, and contributing to the stabilization of infants with varying degrees of respiratory compromise. In essence, FIBs are integral tools in the NICU toolkit, addressing the unique and critical respiratory challenges faced by newborns in their earliest moments of life. 

1. Components and Structure 

• Flow-Inflating Bag: The self-expanding bag is a fundamental component of the Flow Inflating Bag (FIB). Composed of a flexible and resilient material, this bag is designed to inflate spontaneously when connected to a gas source. Its elasticity allows for the bag to collapse when pressure is released, promoting the cyclical ventilation needed for neonatal respiration. The flow-expanding bag serves as the lung surrogate, delivering controlled and measured breaths to the newborn. 

• Oxygen reservoir: The oxygen reservoir within the FIB contributes to the bag's ability to provide a consistent and adequate oxygen supply. This reservoir acts as a buffer, ensuring that a sufficient volume of oxygen is readily available for immediate delivery during each ventilation cycle. This feature is especially critical in neonatal resuscitation, where quick responses and controlled oxygen administration are paramount. 

• Flow Control Valve:  The flow control valve's main purpose is to control the rate at which gas enters the flow inflating bag. By adjusting the flow control valve, respiratory therapists can modulate the volume of gas delivered with each inflation of the bag. This is essential for tailoring ventilation to the specific needs of the neonate, allowing for precise control over respiratory parameters. If there is a good seal, the flow control valve will also control the amount of CPAP/ PEEP being delivered. 

2. Connection to Oxygen Source 

• Oxygen flow rates: Properly connecting the FIB to an oxygen source involves careful consideration of oxygen flow rates.

  The flow rates must be calibrated to meet the specific respiratory needs of the neonate. Adjusting the flow rates ensures

  that the FIB delivers an appropriate volume of oxygen with each inflation, aligning with the infant's oxygenation requirements. 

• Ensuring proper oxygen concentration: Maintaining the proper oxygen concentration is imperative for neonatal respiratory support. FIBs are equipped with mechanisms to regulate and monitor the oxygen concentration delivered to the newborn. Precise adjustments are made to achieve the desired oxygen saturation levels, preventing the risk of hyperoxia or hypoxia. This meticulous control over oxygen concentration is a key factor in the effectiveness and safety of FIBs in neonatal care. 

• Setting PEEP: Setting the PEEP/ CPAP is one of the most important and crucial aspects of using a FIB properly. Completely occlude the mask with your flow set to 8-10 lpm. Watch the manometer and adjust the PEEP Valve until you reach a PEEP of 5cm H20. This is a good starting point and recommended in NRP guidelines. 

3. Fitting the Mask on Neonate's Face 

A. Choosing the Right Mask Size 

• Matching mask size to the neonate's facial anatomy: Selecting an appropriately sized mask is crucial to ensure effective ventilation and prevent potential complications. Neonates come in various sizes, and the mask should be chosen based on the infant's weight, gestational age, and facial dimensions. Matching the mask size to the neonate's facial anatomy promotes a snug fit, optimizing the delivery of positive pressure ventilation and minimizing the risk of air leaks. 

• Avoiding air leaks for optimal ventilation: Proper sizing not only enhances comfort but also reduces the likelihood of air leaks. Air leaks can compromise the effectiveness of positive pressure ventilation, leading to inadequate lung inflation and oxygenation. By meticulously selecting the right mask size, respiratory therapists can minimize the potential for air leaks, ensuring that the delivered breaths are directed into the infant's airways for optimal ventilation. 

B. Securing the Mask 

• Proper placement on the face: Correct placement of the mask on the neonate's face is a critical step in ensuring

  effective respiratory support. The mask should cover the nose and mouth adequately without impinging on the eyes

  or other facial structures. Placing the mask in the correct position facilitates a secure fit and allows for the delivery of

  positive pressure ventilation directly into the airways. 

• Achieving a secure seal without causing discomfort: Achieving a secure seal is essential for maintaining positive pressure

  during ventilation. However, it is equally important to balance this with the comfort of the neonate. Striking the right balance

  ensures that the mask creates an effective seal without causing undue pressure or discomfort. Regular assessment and

  adjustments may be necessary to optimize the fit, taking into account the infant's comfort and the need for consistent and

• reliable ventilation. 

4. Administration of CPAP through the Mask 

A. Overview of CPAP (Continuous Positive Airway Pressure) 

• Benefits of CPAP in Neonatal Respiratory Care CPAP, or Continuous Positive Airway Pressure, is a respiratory support modality that provides a constant pressure to the airways throughout the respiratory cycle, maintaining lung expansion and preventing alveolar collapse. In neonatal respiratory care, CPAP offers several key benefits: 

• Enhanced Oxygenation: CPAP helps improve oxygenation by keeping the lungs inflated, thereby increasing the surface area available for gas exchange. 

• Stabilization of Alveoli: By preventing the collapse of small air sacs (alveoli), CPAP contributes to the stabilization of the respiratory system, particularly in premature infants with underdeveloped lungs. 

• Reduced Work of Breathing: CPAP reduces the effort required for neonates to breathe, allowing them to conserve energy and minimize respiratory distress. 

B. Indications for CPAP use in the NICU 

CPAP is indicated in various clinical scenarios within the Neonatal Intensive Care Unit (NICU): 

• Respiratory Distress Syndrome (RDS): CPAP is commonly used in premature infants with RDS to support their respiratory efforts and prevent atelectasis. 

• Transient Tachypnea of the Newborn (TTN): CPAP may be employed to manage TTN, a condition characterized by rapid breathing shortly after birth. 

• Meconium Aspiration Syndrome: CPAP can be beneficial in infants who have aspirated meconium, assisting in maintaining open airways and improving oxygenation. 

• Increased Work of Breathing: Reduce nasal flaring or grunting.  

C. Connecting the Flow Inflating Bag to CPAP 

• Adjusting CPAP Pressure Settings : Connecting the Flow Inflating Bag (FIB) to CPAP involves setting the appropriate pressure levels to meet the specific needs of the neonate.Typically we start at a CPAP of 5 cm H20 and adjust from there. Careful monitoring and periodic adjustments ensure that the CPAP pressure is sufficient to support the infant's respiratory efforts while preventing overdistention of the lungs. 

• Monitoring Neonatal Response to CPAP:  Vigilant monitoring of the neonate's response to CPAP is essential for evaluating the effectiveness of the therapy and ensuring the infant's safety. Respiratory therapists should assess vital signs, respiratory rate, and oxygen saturation levels regularly. Observation of signs such as decreased work of breathing, improved oxygenation, and respiratory stability indicates a positive response to CPAP. Any adverse reactions or changes in the neonate's condition should prompt prompt reassessment and adjustment of CPAP settings as needed.