skip to main content

Failed CPAP – intubation and surfactant — RACP Paediatrics MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNeonatalFailed CPAP – intubation and surfactantRACP Paediatrics

A 25-week infant on CPAP deteriorates with increasing FiO2 requirement to 0.6, worsening work of breathing, and rising CO2. CPAP pressure is already at 8 cmH2O. LISA has been attempted but the infant desaturated during the procedure. What is the next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Mechanical ventilation

When CPAP and LISA fail, intubation and mechanical ventilation is required. Surfactant should be given via the ETT. Ventilation strategy should be lung-protective: target low tidal volumes (4-6 mL/kg), permissive hypercapnia (pCO2 45-55 mmHg), and early extubation back to CPAP when possible. Volume-targeted ventilation is preferred.

Reference: RCH Melbourne – 2023 – Neonatal Ventilation CPG; RACP Paediatric Curriculum – Neonatology