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Neo welcome back review

Terms in this set (78)

What is the other name for RDS?
Hyaline Membrane Disease
What is RDS/HMD caused by?
Immaturity of the lungs and lack of surfactant
What are the defining features of RDS?
Lack of surfactant (low alveolar compliance and high chest was compliance), increase distance bet alveolar spaces and capillaries and hypoplasia
What does surfactant do?
stabilize the air liquid interface of alveoli and bronchioles and lower surface tension
When does surfactant production begin?
28 weeks
What cells produce surfactant?
type 2 alveolar cells
What is mature surfactant molecules made up of?
90% lipids and 10% glycoproteins
What are some benefits of nasal cannula?
provides tactile stimulation while delivering O2, can feed without interruption, allows for greater mobility
What are the disadvantages of nasal cannula?
FiO2 carries with changes in insp flow and Vt, cannula prongs can become occluded from secretion
What is the FiO2 range of nasal cannula?
0.21-0.70 at flows of 0.25-2 lpm
What are the benefits of high flow nasal cannula?
delivers reliable FiO2 at higher flows (>6 lpm), keeps pt comfortable and delivers 100% relative humidity
What are some disadvantages of high flow nasal cannula?
incorrect cannula size can provide inadvertent positive pressure
What are the FiO2 range for high flow nasal cannula?
0.21-1.0 at flows of 1-8 lpm
What are the benefits of using a face mask?
can provide moderate concentrations of oxygen and provides to both nose and mouth
What are the disadvantages of using a face mask?
FiO2 can vary, must be removed for feeds and can cause skin irritation
What is the FiO2 ranges of a face mask?
0.35-0.50 at flows of 5-10 lpm
What are the benefits of an oxygen hood?
maintains relatively constant FiO2 and doesn't need to attach to pt skin
What are some disadvantages of an Oxygen hood?
Higher FiO2 at bottom of hood, high noise levels and but be set at 5-10 lpm to flush out CO2 and baby can't be held
What are the benefits of using a incubator
requires no additional device to attach to pt and displays set and measure FiO2 continuously.
What is a disadvantage of using an incubator?
When the care ports are open the FiO2 will vary
What is the FiO2 range in an incubator?
0.21-0.65
What are the target saturation for kids?
88-92%
What causes a increased risk of brain damage when using high O2?
The instability of the blood vessels in the germinal matrix
what can happen to the type I cells if we use too high of an FiO2?
Permanent structural damage
What are the 3 major reasons to avoid excessive O2 delivery?
Increased risk of brain injury, increased rental damage/retinopathy and structural damage to alveoli
What do excessive free radicals do to DNA?
Mutate it
What is the flow rate recommended for a pt 0-12 kg?
2 l/min/kg with a max of 25 l
What will happen if you provide higher flow than recommended for the prongs on opti flow?
The pt will only receive the flow that the prongs will allow
What is the major difference between CPAP and NIPPV?
CPAP has one pressure level where as NIPPV has 2 pressure levels
What are the indications for CPAP
Increase WOB, infiltrated lung fields, extubation from mech vent, inability to maintain PaO2 >50 mmHg on less than 60% or PaCO2 >50 mmHg and pH of <7.25
does CPAP or NIPPV have a higher Paw?
NIPPV
What are the 6 goals of mechanical ventilation in kids?
Facilitate alveolar ventilation and CO2 removal, provide adequate tissue oxygenation, reduce WOB, Support spontaneous efforts avoid injury, minimize cardiac circulation interference
What phases are active in HFOV?
Both inspiration and expiration
What phases are active in HFJV?
inspiration ONLY
At what ratio do we see a choke point?
greater than 3:1
What type of ventilation has a choke point?
HFOV
What is compared in the choke point ratio
delta p and pAW
What type of high frequency ventilation needs 2 vents?
HFJV
What functions does the conventional ventilator provide in HFJV
Bias flow, maintains PEEP, provides sigh breaths
What is a normal PIP in HFJV?
Up to 50 cmH2O
what is a normal Ti in HFJV?
0.02-0.035
What is a normal RR in HFJV?
240-420
What does AOP mean?
Apnea of prematurity
What is AOP?
A sudden cessation of breathing that lasts for at least 20 seconds or is accompanied by bradycardia or defat in an infant younger than 37 weeks
What are the causes of AOP?
Incorrect neural signalling or obstruction
What can cause incorrect neural singling that causes AOP?
Immaturity of the neurological and chemical receptor systems of the body that regulate respiration and respond to hypoxemia and hypercapnia
What is the definition of periodic breathing?
a benign abnormal form of breathing with cycles of hyperventilation followed by short apneic pauses of <3 sec
What are the 3 classifications of AOP?
Central, obstructive and mixed?
What is BPD?
bronchopulmonary dysplasia
What is the definition of BPD?
Chronic lung disease which the infant needs O2 for longer than 28 days post birth
what is the pathophysiology of BPD?
Alveolar hypoplasia, abnormal pulmonary vascular and airway development after delivery
What is PPHN?
A syndrome with severe hyperoximia and high pulmonary artery pressures that occurs when the PVR normally high in utero fails to decrease
What characterizes PPHN?
A failure to establish adequate pulmonary and systemic oxygenations
what is the normal treatment of PPHN?
20 PPM of NO
What can result if PPHN is left without treatment?
cardiac dysfunction, multi organ dysfunction and death
what happens when pulmonary pressures are greater than arterial pressures?
right to left shunt
if there is a right to left shunt where does the blood shunt through?
Ductus arteriosus or foramen ovale
what are the 3 classifications of PPHN?
Underdevelopment, maldevelopment and maladaptation
What are the initial causes of PPHN?
Asphyxia, increased PVR, hypoventilation, sepsis, MAS
What can cause the DA to remain patent?
Decreased PO2
What is the goal for the lungs while on ECMO?
Prevent iatrogenic damage caused by high Paw
What is the goal for the heart while on ECMO?
Prevent the use of high doses of toxic meds to keep heart functioning
What are the 2 types of ECMO?
vv and va
what is the main function of NO?
Selective vasodilator, platelet inhibition, immune and enzyme regulation and neurotransmission
What can happen if we give too much NO?
met Hb production
What does NO do to bleeding?
It can affect platelet formation and bleeding time which can increase risk for IVH
what are some hazards of using high levels of NO2
Pulmonary oedema or changes in lung tissue and development of nitric acid
what is the definition of MAS?
Resp distress occurring soon after delivery in meconium stained infant
what type of disease process is MAS?
Obstructive
what population does MAS affect most?
Term and post term
what is chemical pneumonitis?
Inflammation of the lungs due to the inhalation of certain chemicals
What can MAS result in?
obstruction, chemical pneumonitis, atelectasis and pulmonary hypertension
What is TTN?
transient tachypnea of the newborn
What is TTN characterized by?
mild respiratory distress during the first hours of life
What is TTN caused by?
failure to clear fetal lung fluid prior to delivery
How long does TTN last for?
up to 72 hours
What can be used in kids with TTN?
CPAP
What are the main risk factors associated with TTN?
c section, big baby, maternal asthma and diabetes and malg gender
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