Neuromuscular Compromise and Respiratory Failure — General Guidance on Oxygenation — Clinical Pathway: Inpatient and PICU

Neuromuscular Compromise and Respiratory Failure Clinical Pathway — Inpatient and PICU

General Guidance on Oxygenation

Goal SpO2 ≥ 95% in room air for all patients. Patients with neuromuscular disorders should be assumed to have normal lungs and at baseline should not require supplemental oxygen. This may not be true in patients with intercurrent lower airways disease (bacterial or viral pneumonia),but should be the goal once illness starts to resolve and prior to weaning increased support and airway clearance.

Patients with acute respiratory illness have may lower have SpO2 goals during their illness. Until illness resolves, goal SpO2 ≥ 92%.

Hypoxemia is a symptom of underlying lung pathology such as pneumonia, atelectasis or hypoventilation. Supplemental oxygen should not be applied without addressing airway clearance and adequacy of ventilation.

  • MI-E (CoughAssist) with suction can be used as often as needed to clear lower airway secretions and with any acute SpO2 drop < 92%.
  • If in room air and SpO2 remains ≤ 92%: Apply respiratory support device (NIV or ventilator) and reassess frequency of therapy.
  • If patient is requiring supplemental oxygen, add to the MI-E (CoughAssist) and continue Q2.

If there is persistent difficulty with airway clearance, add in IPV with/without 3% hypertonic saline or HFCWO (Vest®).

Frequency

  • Should not exceed Q4 hours and to be done before MI-E.
  • If hypertonic saline ordered, order PRN. Maximum frequency Q6.

Considerations

  • Assess IPV tolerance — may have a notable increase in TcCO2 (transcutaneous capnometry) if not tolerating.
  • There is no evidence to support the use of hypertonic saline.