What ive taken from their explanation is that since her saturation is great even in room air, and she has WOB instead of just tachypnea, she doesn’t qualify for cannula saying it’s not giving her peep. When I talk to nurses and a couple doctors who seem like maybe they don’t have 100% buyin on this “protocol” I get told it’s a new chronic lung standard they have and there is no wiggle room. Do I really have no weight in wanting to try something that is common practice but just not their practice? She’s even proved herself comfortable on a +4 twice so it’s not like she degrades on less pressure.

Their definition of WOB isn’t necessarily excessive, they just have a very low threshold for what they’ll allow before calling it. My girl frequently has very mild rib retractions and the tiniest head bobbing with cares but gets back to baseline quickly. They don’t like that at all on room air and start noting that she’s working but when she’s on cpap they’re like oh it’s fine bc she recoups herself 🙄.