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TAS Neonatal Medicine ✅ > Artificial Respiratory Suppport ✅ > Flashcards

Artificial Respiratory Suppport ✅ Flashcards

1
Q

What can artificial respiratory support be classified into?

A
  • Non-invasive respiratory support

- Invasive respiratory support

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2
Q

How is invasive respiratory support given?

A

Via a tracheal tube

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3
Q

What are the levels of support that can be given in artificial respiratory support?

A
  • Single level support

- Intermittent positive pressure ventilation

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4
Q

Give 2 examples of single level respiratory support?

A
  • CPAP (continuous positive airway pressure)

- HFNC (high flow nasal cannula)

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5
Q

What does single level respiratory support provide?

A

A form of distending pressure

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6
Q

Does single level respiratory support provide mechanical breaths?

A

No

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7
Q

Who is single level respiratory support suitable for?

A

Babies who are breathing spontaneous and have sufficient central drive

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8
Q

What is required if babies are not breathing spontaneously and show signs of respiratory failure?

A

Intermittent positive pressure ventilation

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9
Q

How can intermittent positive pressure ventilation be delivered?

A

Via a tracheal tube or nasal prong

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10
Q

What do the ventilatory needs of a patient depend largely on?

A
  • Mechanical problems of respiratory system

- Type of abnormality in gas exchange

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11
Q

What drives the flow of gases in the lungs?

A

The pressure gradient between the airway opening and alveoli

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12
Q

What determines the pressure gradient necessary for adequate ventilation?

A
  • Compliance

- Resistance

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13
Q

What does compliance describe?

A

The elasticity or distensibility of the lungs or respiratory system (lungs + chest wall)

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14
Q

How is compliance calculated?

A

Volume / pressure

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15
Q

What is the normal compliance of infants lungs?

A

3-5ml/cmH2O/kg

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16
Q

Give a condition that lowers the compliance of infant lungs

A

RDS

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17
Q

What is the compliance of an infants lungs in RDS?

A

0.1-1ml/cmH2O/kg

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18
Q

What does resistance describe?

A

The ability of the gas-conducting parts of the lungs or respiratory system to resist airflow

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19
Q

How is resistance calculated?

A

Pressure/flow

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20
Q

What is the resistance in normal infant lungs?

A

25-50cmH2O/L/second

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21
Q

Is resistance altered in RDS?

A

Not markedly

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22
Q

What can increase resistance in infants lungs?

A

Small endotracheal tubes

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23
Q

By how much can small endotracheal tubes increase the resistance in fetal lungs?

A

To 100cmH2O/L/second or more

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24
Q

What is meant by the time constant?

A

The time (milliseconds) necessary for the alveolar pressure (or volume) to reach 63% of a change in airway pressure (or volume)

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25
Q

How is the time constant calculated?

A

Compliance x resistance

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26
Q

What duration of inspiration or expiration is required for inspiration or expiration to be relatively complete?

A

3-5x the time constant

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27
Q

What is the implication of needing a duration of 3-5x the time constant for relatively complete inspiration or expiration?

A

The time constant is affected by resistance and compliance, and so the inspiratory and expiratory times are also affected by resistance and compliance

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28
Q

What happens to the time constant if the compliance is decreased?

A

It will be shorted

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29
Q

What effect does RDS have on inspiratory times?

A

RDS decreases compliance, so decreases the time constant, so enables shorter inspiratory times to be effective

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30
Q

When will the time constant be higher?

A
  • If compliance is high

- If resistance is high

31
Q

When might resistance in the lungs be high?

A

In bronchopulmonary dysplasia

32
Q

On what basis can ventilators be classified?

A
  • By the variables that are controlled, e.g. pressure or volume
  • If they start (or trigger), sustain (or limit), and end (cycle) inspiration
  • If they maintain expiratory support (or baseline pressure)
33
Q

What is the function of a pressure controller ventilator?

A

Controls airway pressure

34
Q

What are the types of pressure controller ventilators?

A
  • Positive pressure ventilators

- Negative pressure ventilators

35
Q

What do positive pressure ventilators do?

A

Make the airway pressure rise above body surface pressure

36
Q

What do negative pressure ventilators do?

A

Make airway pressure fall below the body surface pressure

37
Q

What do volume controller ventilators to?

A

Controls and measures the tidal volume generated by the ventilator

38
Q

What do flow controller ventilators do?

A

Controls the tidal volume by limiting gas delivery by flow

39
Q

What does a time controller ventilator do?

A

Controls the timing of a ventilatory cycle but not the pressure or volume

40
Q

What kind of ventilators are high frequency ventilators?

A

Time controllers

41
Q

What aspects need monitoring in infants on ventilators?

A
  • Underlying lung pathology
  • Response to treatment
  • Surveillance for associated complications
42
Q

What are the categories of monitoring used in infants on ventilators?

A
  • Clinical evaluation
  • Assessment of gas exchange
  • Chest imaging
  • Pulmonary function and pulmonary mechanics testing
  • Cardiac monitoring with echocardiography and imaging
43
Q

What does clinical evaluation include when monitoring infants on ventilators?

A

Observation for general physical condition and complications of mechanical ventilation

44
Q

Give 2 examples of complications of mechanical ventilation?

A
  • Gas trapping

- Air leaks

45
Q

What features may suggest air hunger or increased work of breathing?

A
  • Rapid shallow breathing

- Subcostal/intercostal retraction

46
Q

How can air hunger/increased work of breathing be corrected in a ventilated infant?

A

Augmentation of ventilator parameters

47
Q

What might suggest a left-to-right shunt via a PDA in a ventilated infant?

A
  • Hyperactive precordium

- Presence of a cardiac murmur

48
Q

What might suggest persistent pulmonary hypertension of the newborn (PPHN) in a ventilated infant?

A
  • Cyanosis

- Desaturation on pulse oximetry

49
Q

How can a pneumothorax be identified quickly in a ventilated infant?

A

Bedside transillumination with a fibre-optic light source applied to the chest wall

50
Q

How can gas exchange be assessed in a ventilated infant?

A

Blood gas assessment

51
Q

What makes assessment of gas exchange difficult?

A
  • Has to be interpreted in clinical context

- Wide range of normal blood gas values

52
Q

What factors should be taken into account when assessing blood gases?

A
  • Work of breathing
  • Recent trends
  • Stage of illness
53
Q

What does the normal blood gas value depend on?

A
  • Gestational age
  • Postnatal age
  • Source (arterial, venous, or capillary)
  • Disease status
54
Q

What is oxygenation dependent on?

A

Ventilation-perfusion matching

55
Q

What is elimination of CO2 from the blood dependent on?

A

Alveolar ventilation

56
Q

How is alveolar ventilation calculated?

A

Tidal volume x respiratory rate

57
Q

How is the pH of the arterial blood determined?

A

Primarily by PaCO2, lactic acid, and buffering capacity

58
Q

What produces lactic acid?

A

Anaerobic metabolism

59
Q

What is particularly important in determining the buffering capacity?

A

The serum or plasma bicarbonate and plasma haemoglobin concentration

60
Q

What is the base deficit in a healthy term infant?

A

3-5 mEq/L

61
Q

What is the difficulty of interpreting base deficit in a ventilated infant?

A

Base deficit can vary widely

62
Q

What is an acceptable base deficit in a baby?

A

5-10 mEq/L (assuming reasonable perfusion)

63
Q

What should be done if a ventilated infant has a base deficit of >10mEq/L?

A

Careful assessment for evidence of hypoperfusion

64
Q

What is usually the best way of managing metabolic acidosis?

A

Correcting the cause

65
Q

What is the use of CXR in NICU?

A
  • Diagnosis

- Monitoring the course of a disease process

66
Q

What are the problems with CXR?

A

Poor specificity

67
Q

What needs to be remembered when considering a CXR?

A

Needs to be interpreted in context with the clinical information

68
Q

What is the limitation of the use of CXR for diagnosis?

A

Findings are mostly suggestive of pathology rather than being diagnostic

69
Q

How can pulmonary function and pulmonary mechanics testing be done in ventilated infants?

A

Using pulmonary graphics on the ventilator

70
Q

What can pulmonary function and mechanics testing be useful in determining in ventilated infants?

A
  • Dynamic compliance
  • Airway resistance
  • Inspired and expired tidal volumes
71
Q

What can the use of pulmonary function and mechanics testing facilitate?

A

The use of gentile ventilation

72
Q

What is the purpose of gentile ventilation?

A

Minimising ventilator-induced lung injury

73
Q

How can cardiac monitoring be carried out in a ventilated infant?

A
  • Echocardiography

- Imaging

74
Q

What is cardiac monitoring useful for in ventilated infants?

A
  • Confirm diagnosis of PDA and assess ductal shunting

- Identify PPHN and congenital heart disease

TAS Neonatal Medicine ✅ (35 decks)

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