Two days of Paediatric & Neonatal ventilation course
SRI LANKA COLLEGE OF PAEDIATRICIANS
NO 44/1, GNANARTHAPRADEEPAMAWATHA
COLOMBO – 10
OPPOSITE: LRH MAIN GATE ON MARADANA ROAD
TELE – 0778872007
Lady Ridgeway Hospital
Entrance from Maradana
Course conducted by Paediatric Intensivists and Neonatologists of Sri Lanka College of Paediatricians
Justification for Paediatric & Neonatal ventilation course
Sri Lanka has made remarkable progress in reducing the under-five year mortality rate. During the last two decades major causes of death are Dengue shock syndrome, Respiratory problems and Prematurity related problems. Sri Lanka is very strong when it comes to Basic Newborn Care because of a well-placed public health system and the input from the paediatric curative management community.
In order to reduce ventilation related deaths, both inside and outside intensive care units, Paediatric care givers should understand basic principles of respiratory physiology, gas exchange and meticulous approach to respiratory strategies in different lung pathologies varying from simple pneumonia to adult respiratory distress syndrome.
These include rationale behind the application of simple face mask oxygen to High-flow oxygen in the ward settings, Non-invasive ventilation to conventional ventilation to high frequency ventilation.
Target group – paediatric care givers, both doctors and nurses.
History of Paediatric & Neonatal ventilation course
In Sri Lanka, Paediatric and Newborn Ventilation was first started in 1985, by Dr. D. A. Sonnadara at the Paediatric Intensive Care Unit, Lady Ridgeway Hospital for Children and at Sri Jayawardenapura Neonatal Intensive Care Unit. While the ventilator care of the newborns at Neonatal unit at Sri Jayawardanapura was managed by Paediatricians, Paediatric ventilation at Lady Ridgeway Hospital for Children was managed by Dr Sunil Wijesooriya, Senior Anaesthiest.
Since then, Neonatal Ventilation at the Neonatal Intensive Care Units have been undertaken by General Paediatricians who were trained on ventilation during their overseas training in the UK and Australia. In November 2001, Ministry of Health appointed the first full time paediatrician to PICUs and they took over the unit from Consultant Anaesthists.
In 2005 Board of Study in Paediatrics decided to commence sub-specialization in Neonatology and Paediatric Intensive Care, leading to Board Certification of Neonatologists and Paediatric Intensivists.
Prof Ahoak K. Deorari from the Department of Paediatrics, WHO Collaborating Centre for Education& Research in Newborn Care, All India Institute of Medical Sciences, India, was an invited speaker for the Asia Pacific Pediatric Association Congress, organised by Sri Lanka College of Paediatricians in 2007. During his visit to Sri Lanka, one day ventilation workshop was held for 70 participants at the Lady Ridgeway Hospital. This initiated an interest in Paediatric and Neonatal ventilation in Sri Lanka as there were gaps in the knowledge of neonatal ventilation by Sri Lankan care givers.
Prof Ashok Deorari and his team from India conducted a four-day Advanced Neonatal Ventilation course, organized by Dr Srilal de Silva through the Perinatal Society of Sri Lanka under the patronage of Prof Sujeewa Amarasena, the then the President of the society. Sixty doctors were trained which included 48 Consultant Paediatricians. The UNICEF was the sole sponsor for this workshop. Following this stimulating workshop, there had been a growing interest among the neonatal care givers on neonatal ventilation.
CPAP is a non-invasive type of ventilation, which reduces the necessity for mechanical ventilation by 50%. Even though, a few CPAP machines were available in 2006, there was no structured programme to educate the health-care workers on the use of CPAP ventilation.
Having completed the Advanced Neonatal Mechanical ventilation, Prof Ahoak K. Deorari stressed the need to introduce Neonatal CPAP ventilation. He discussed this concept with the UNICEF representative Dr Mohamed Hussain who readily volunteered to support that initiative. He facilitated 4 master training programmes in Colombo and Kandy in 2009 (2 workshops), 2010 and 2011. Nearly 180 doctors and nurses were trained by these workshops. Prof Ahoak K. Deorari sent the printed manuals on CPAP from India.
In November 2015, Paediatric BASIC course was held in Colombo for the first time by an Australian Faculty lead by Dr Bruce Lister. This module addressed Paediatric Ventilation and intensive care related topics. 35 doctors and 8 nurses were trained and they had to do on-line pre-course MCQs as a pre-requisite for attending the course.
In November 2016 two Paediatric BASIC courses were held in Colombo and Kandy for 70 participants (doctor and nurses) while in November 2017 one Paediatric BASIC course for doctors was held.
Bruce Lister stressed the need to include nurses into the programme in 2015. With his perseverance and guidance, SLCP was able to organise the Paediatric BASIC for nurses with the help of the Australian Faculty in November 2017. This was the first time that the Paed BASIC course was held only for nurses and teaching was done by local nurses under the supervision of Australian nurses.
Two days comprehensive ventilation modules were commenced by the Sri Lanka College of Paediatricians from 2012. Since then College of Paediatricians has been facilitating 2- 3 two day ventilation modules per year up to now.
Programme Summary and the manual
Recommended manual – Neonatal and Paediatric Ventilation manual by
Dr. Praveen Khilnani, MD FAAP, MCCM (USA), Diplomate American Board of Pediatrics and Pediatric Critical Care Medicine, Clinical Director, Senior Consultant in Paediatrics, Pediatric Pulmonology and Critical Care, RAINBOW Children’s Hospital, Delhi, INDIA
Lecture Topics covered
- Place of ventilation in children & Acute Respiratory Failure
- Oxygenation – Clinical concepts & CO2 elimination and Et CO2
- Mechanical Ventilation – Basics & Physics Pressure Control vs Volume Control
- Mechanical Ventilation – Modes SIMV, IMV,
- Basic concepts of NIV (CPAP & HFNO)
- Monitoring during ventilation – Pulmonary graphics
- Disease specific ventilation – Asthma, Lung recruitment strategies , PEEP titration, ARDS
- Mechanical Ventilation – Complications & Troubleshooting
- Ventilator Asynchrony
- Heart lung interaction and Ventilating a cardiac patient
- What is humidity?
- Prevention of ventilation associated pneumonia
- Care of the ventilated baby
- Setting up of the ventilator
- Non-invasive ventilation – High flow oxygen, BiPAP
- Neonatal CPAP flow driver / Neopuff
- Weaning, Ventilator Asynchrony
- Ventilation during Transport
- Volume Control Ventilation
- Arterial Blood Gases
- Sedation & Analgesia in Ventilation
- Ventilating a new born lung, Sdd, PPHN, Meconium aspiration, Pulmonary Haemorrhage
- Fluid balance, humidification suctioning, physiotherapy, turning etc. Routine Nursing Care in PICU