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What happens when you have a great deal of atelectasis?
↑ PaCO2 (hpercapnia) not able to ventilate
Which cause acidosis
↓ PaO2 (hypoxemia)
How does gas exchange, if you are ventilating a pt. less than dead space volumes?
HFOV (High Frequency Oscillation Ventilation)
What are the typical blood gases you will see in a pt. w/ BPD?
Chronic lung disease (COPD)
- pH normal (compensated)
- ↑ CO2
- ↓ O2
- ↑ Bicarb
If need to intubate a neonate/infant w/ RDS, what do you do?
- Mechanical ventilation ( the low Vt strategy)
- Use the lowest PIP (peak inspiratory pressures)
- Use the lowest FiO2 to maintain blood gases
What is the primary disease of prematurity?
What do you think will happen to the lungs if all this air escaping into the interstitium? (Interstitium surrounds and supports the lungs?
- The air will compress the lungs
- Compress the vessels
- Cause ↓ lung compliance
What happens to the ventilator settings if you have lung compliance?
Will need to use higher ventilator settings
What is the major underling cause of RDS?
What are some complications associated w/ RDS?
How is RDS treated?
- If need assistance w/ RR use CPAP noninvasive b/c you want to minimize barotrauma
- Use lower Vt strategy, which will minimize barotrauma
- Surfactant replacement therapy (SRT)
which ↓ surfactant
What is BPD?
- Bronchopulmonary Dysplasia
- It is a result from the adverse effects of mechanical ventilation
What are the adverse effects of mechanical ventilation?
- Extensive lung injury by barotrauma (which is too much pressure)
- Volume trauma ( trauma from excessive volumes)
How do you treat BPD?
- Prevention/treatment is low Vt strategy
- Minimize barotrauma
- Permissive Hypercapnia
- Surfactant Replacement Therapy (SRT)
- Having sever oxygenation issues
- Nitric Oxide
- Vitamin A
- Close off PDA # 1
What is ROP?
- Retinopathy of Prematurity
- It is the constriction of the blood vessels
- too much oxygen causing the retina blood vessels to constrict and the blood vessels die and forms a scar in the lens of the eyes and this is how the blindness occurs.
How can you prevent ROP?
- Use very cautious use of oxygen
- The more premature they are the higher the incidence of ROP.
- Need to set Spo2 high alarm
Which neonates are at the greatest risk for developing ICH/IVH?
Less than 32 weeks gestation and less than 1500 grams
What is the most common cause of ICH/IVH?
- Premature of the CNS
- Meaning the head
What is PIE?
- Pulmonary Interstitial Emphysema
- This is a leak syndrome
- Where the air escapes into the pulmonary interstitium
How do you treat PIE?
- HFOV or low Vt strategy
- B/c increase pressure will worsen it. This is what caused PIE in the 1st place.
What are two complications associated w/ O2 administration?
- Knock out respiratory drive
- Nitrogen washout - Leading to absorption atelectasis
What is a quick method used to diagnose pneumothorax in neonate and young infants?
What do you set in pressure control ventilation?
- Pressure (PIP)
- Influence of airway resistance, lung compliance
- I-time- Vt varies
On the Avea what modes is available only in the neonatal size that is pressure based?
- Timed Cycle pressure Limited
- you set a pressure (neonate/infants)
When setting a PIP on a vent. For a neonate/infant, what do you look for?
- Ehxhaled Vt
- Good chest rise and fall
- Good chest expansion
- Look at X-Ray- Will count the number of ribs to which that lung is inflated (rib 8-9).
- if not inflated enough will turn up the PIP
- If lungs are over inflated they will turn down the PIP
What do you set in volume control?
- Volume (Vt)
- RR (frequency)
- Flow rate