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Oxygen Therapy and Assisted Ventilation
Because hypoxemia is generally severe, oxygen administration is critical in foals with NRDS. The fraction of inspired oxygen (Fio2) can be enriched by oxygen insufflation using a mask or an intranasal or endotracheal tube. Nasal insufflation of humidified oxygen is generally administered at 2 to 15 L/min.4 Although predicting the resulting Fio2 is impossible and monitoring is important, nasal insufflation is unlikely to result in toxic levels of oxygen. If instituted before a foal has fatigued, nasal oxygen insufflation often provides adequate respiration in a premature foal with functionally immature surfactant. However, oxygen insufflation alone is likely to be insufficient in foals with severe surfactant dysfunction and respiratory fatigue. Therefore, assisted ventilation is necessary in those cases. Because manually assisted ventilation is unlikely to provide adequate gas exchange, mechanically assisted ventilation (using positive end-expiratory pressure) is recommended. Among the different modes of ventilatory support, continuous positive airway pressure (CPAP) is generally required to effectively decrease Paco2 and achieve