Prolonged Mechanical Ventilation: Challenges to Nurses and Outcome in Extremely Preterm Babies

Abstract

Worldwide, about 15 million infants are born prematurely each year. Technological advances, including invasive mechanical ventilation, play a major role in the survival of extremely preterm babies. Those who survive may have prolonged morbid conditions that result in long-term sequelae. Nurses face several challenges during the hospitalization of these infants. Vigilant care, monitoring, and careful handling of the infants can prevent infections and long-term complications. Newer, less invasive technologies are promising for improved outcomes in extremely preterm infants. (Critical Care Nurse. 2015;35[4]:58-66)

Respiratory Care for the Ventilated Neonate

“…Highly sensitive equipments are helpful for the monitoring of the patient. Alarm limits (upper and lower) for heart rate, respiration, blood pressure, and oxygen saturation are set on the basis of current evidence and the NICU's specific standard of care [ 40 ].…”

“…Nurses must provide a safe environment for the infants in the unit and regulate the infection control policies [ 40 ].…”

“…Hand washing, isolation, surveillance, and screening of visitors are relevant aspects to nurses in the NICUs [ 40 ].…”

Should Euthanasia Be Considered Iatrogenic?

“…These invasive interventions, meant to preserve life, can have foreseeable, but unintended negative consequences, which by definition are iatrogenic. Central line-associated bloodstream infections can lead to septic shock and multisystem organ failure; prolonged mechanical ventilation increases the risk for chronic lung disease, with some infants remaining ventilator-dependent, and is also associated with retinopathy of prematurity [17]. Euthanasia for extremely premature infants thus might be viewed as a morally justifiable and even noble action, since the goal is to relieve suffering.…”

“…To illustrate, one need only imagine early experiences of many extremely premature newborns; most would not survive were it not for life-sustaining interventions, including intubation and mechanical ventilation. These interventions prolong life but often contribute to disability [17]; accordingly, they are intrinsically iatrogenic. And yet a prevailing view remains that these interventions are noble and constitute the "right thing to do" because they aim to protect and preserve life by giving every baby and family a chance at a happy and fulfilling life.…”