Chronic Lung Disease Flashcards

Question

Why has surfactant not been shown to decrease the incidence of BPD?

Answer 1

r/t increased number of ELBW survivors

Answer 2

1) route for "rain out" 2) dysplastic airway ∆ (tracheomalacia, etc) 3) distrupt ciliary bodies and cells are replaced with less effective functioning, hyperplasia cells 4) portal of entry for infection

Answer 3

occurring with increasing frequency as smaller and more immature infants are surviving; occurs even after gentle ventilation techniques - affects subsequent alveolarization and pulmonary vascular development

Answer 4

around day 10-12, the ductus is open, pneumonia, fluid overloaded may be apart of the natural course of a lung thats not supposed to be exposed to O2 or functioning >>> there is a progressive decline in respiratory fx

Answer 5

- smaller infants affected ( 400 g +) - early mechanical ventilation followed by a "honeymoon" - second week dwindles - often require ventilation and supplemental O2 for months - clinical progression is accompanied by a slow improvement and gradual weaning of support (small # of affected babes demonstrate a more severe course)

Answer 6

- progressive respiratory failure - pulmonary HTN (some arteries become so hypertrophied that it induces RVH) - cor pulmonale - death

Answer 7

heart failure secondary to lung dz

Answer 8

1) fluid overload 2) infection 3) aspiration 4) L > R shunts (VSD, PDA, ASD)

Answer 9

- last generations of the lung periphery are formed - epithelial differentiation - air blood barrier formed essentially you are using airways for gas exchange, which will work for a little while

Answer 10

trauma attributed to pressure; some studies say that it is volutrauma that is more damaging

Answer 11

as few as 6 too big breaths (tV); this damage can lead to protein leaks from capillaries into alveolar space; that protein sucks in O2 and sets the stage for pulmonary edema

Answer 12

a primary lung injury is not always evident at birth; the secondary development of a persistent lung injury is a/w an abnormal repair process and leads to structural changes such as arrested alveolarization and pulmonary vascular dysgensis.

Answer 13

hyperoxia can have major effects on lung tissue, including: 1) proliferation of alveolar type II cells and fibroblast 2) alterations in surf system 3) increases in inflammatory cells and cytokines 4) increased collagen deposition 5) decreased alveolarization and microvascular density 6) pulmonary edema

Answer 14

the association for persistent need for mechanical ventilation and supplemental oxygen in the first 2 weeks of life is not as dominant as in the past - O2, independent of mechanical ventilatory support can cause lethal damage to previously normal lungs

Answer 15

85-93%; has lead to a decrease in the need for supplemental O2 at 36 weeks PMA in this post surf era

Answer 16

this is the new key and the one element we don't have control over - the lung is developing ex utero > it shouldn't be opening and closing yet or getting blood flow through it

Answer 17

in utero receives < 7% of CO; after birth receives 100% | - vessels are not developed enough to handle that volume or to be perfused at that time

Answer 18

an exaggerated inflammatory response (alveolar influx of numerous proinflammatory cytokines as well as macrophages and leukocytes) occurs in the first few days of life; neutrophils "eat" the bacteria and then continue onto the alveoli themselves

Answer 19

there are some bacteria that are seen in increased incidnce in tinier babes; Ureaplasma; unfortunately, tx of these organisms has not decreased incidence of BPD and secondary infx exacerbate it (E coli, Klebsiella, Pseudomonas)

Answer 20

essentially an effect from leak; "a dry lung is a happy lung"

Answer 21

big problem as blood shunts L > R as pulmonary vascular resistance decreases and ends up flooding their lungs - one reason they tried PDA prophylaxis

Answer 22

caused from injury by ETT ruining cilia and the body responds by increasing layers of cells

Answer 23

necessary to keep the baby growing and facilitate healing; fatty acid isotiol has been a/w healing

Answer 24

one of the few tx that has decreased rate of BPD by 6%

Answer 25

steroids; can cause vitamin A toxicity

Answer 26

1) PREMATURITY 2) race (white) 3) sex (male) 4) chorioamnionitis 5) tracheal colonization with ureaplasma 6) ELBW 7) RDS 8) vitamin A deficiency 9) excessive IVF administration 10) sepsis 11) PDA 12) oxygen therapy 13) family h/o atopic disease

Answer 27

- not necessarily wholey d/t lung immaturity - increased risk of ventilatory support (sometimes prolonged) - infx, sepsis, maternal chorio - younger GA: increased risk of BPD (uncommon after 32 weeks)

Answer 28

- high airway pressure (barotrauma) - high tV (volutrauma) - lack of adequate recruitment (atelectotrauma) - ventilation induced lung injury increases cytokine production - HFOV has not proven to prevent of decrease severity of BPD

Answer 29

if you are too gentle, then alveoli collapse and you have to open it back up again, much more likely to cause trauma if you let it collapse > need high pressure to reopen

Answer 30

- avoid prophyactic intubation - make them declare HMD and CPAP failure, CXR c/w RDS, increased WOB and FiO2 > 40% - trend toward in/out surf with early CPAP maintenance

Answer 31

< 1000g with CO2 > 70 (set up increases risk for IVH), but if you intubate, you increase risk for BPD, but you don't want to wait for total collapse and atelectotrauma

Answer 32

- alveolar edema - neutrophil infiltration - alveolar cell proliferation - fibrosis

Answer 33

classic: (pre surf) normal appearing airways, less fibrosis and more uniform inflation new: deficient septation, leading to fewer and larger alveoli with possible reduced pulmonary capillarization that may lead to PPHN

Answer 34

no evidence that higher ranges improved growth or development but it did increase days of oxygen threapy and use of health care resources

Answer 35

inflammatory cascade simulates surf production (less HMD) but then results in neutrophil infiltration and later parenchyma inflammation (more CLD)

Answer 36

1) oxygen 2) high pressures 3) increased pulmonic blood flow

Answer 37

increased inflammatory stimulus in the first 5 days of life correlate with developing BPD (IL-6, IL-1Bb, IL-8, TNF-a)

Answer 38

ureaplasma urealyticum

Answer 39

1) coag neg staph 2) CMV 3) RSV most common are gram neg (pseudomonas and klebsiella)

Answer 40

1) excess fetal lung fluid per unit lung mass 2) fewer Na channels and less Na, K, ATPase activity in epithelium 3) increased lung vascular filtration pressure 4) increased lung epithelial protein leak with postnatal ventilation 5) increased lung vascular protein permeability - if infant doesn't lose wt within first week of life, more likely to have BPD

Answer 41

infants that later develop BPD have been shown to have increased pulmonary resistance in the first week of life- possibly from obstruction

Answer 42

- epithelial hyperplasia - edema - inflammation

Answer 43

- family h/o reactive airway dz - glutathione S- transferase P1 gene - if you have a twin with BPD, you are more likely to have BPD

Answer 44

general under nutrition, particularly an insufficiency in dietary protein may increase the vulnerability of the PTB to oxidant lung injury and the development of BPD

Answer 45

- similarities b/w epithelial ∆ seen with vit a deficiency and BPD - lower levels of vit a in the first week show increased risk of BPD - administration of vit a in the first week of life shown to be protective against BPD

Answer 46

magnesium deficiencies increase the susceptibility of cells to perioxidation and worsens inflammatory reactions (weak evidence)

Answer 47

is essential compoent for the antioxidant glutathione peroxidase; investigations into this trace metal have not borne out just yet

Answer 48

inositol serves as a precursor to surfactant and has been reported to be deficient in PTB. one study improved survival without BPD with supps (not confirmed)

Answer 49

increased incidence of PDA increased lung inflammation increased risk of BPD

Answer 50

to treat adrenal insufficiency; larger trial showed benefit only to infants exposed to chorio

Answer 51

- spontaneous bowel perforations | - some evidence suggests that steroids is damaging to the developing lung and can stop its branching

Answer 52

- free Fe increases oxidative stress - malondialdehyde, a biochemical marker of lipid perioxidation, measured in BAL specimens from ventilated patient was found to be elevated s/p tx

Answer 53

you look at 3 stages: 1) antenatal drugs and management aiming to prevent BPD 2) postnatal drugs and management strategies aimed at preventing BPD 3) strategies aimed at improving clinical outcomes of infants with established BPD

Answer 54

1) promote maturation of surf 2) increase antioxidant capacity 3) increased activity of lung endothelial nitric oxide synthase (net result is a decrease in RDS; no clear evidence that this decreases BPD) - also protective against IVH

Answer 55

1) increased expression of VEGF (dex) leading to decreased alveolarization 2) multiple courses of prenatal steroids are a/w risk for BPD 3) a decrease in lung to body weight ratio 4) prenatal steroids given in presence of inflammation have short term anti-inflammatory effects with later rebound of inflammation to higher levels

Answer 56

the benefit of lung maturation may lead to increased survival but be somewhat off set by an increased susceptibility to lung injury and rebound inflammation

Answer 57

involved in fetal lung growth and maturation and act with glucorticoids for surfactant synthesis; the basis for prenatal thyrotropin- releasing hormone

Answer 58

- early, small trials were promising - larger trials showed TRH and steroids no more effective in preventing RDS than steroids alone. Furthermore, those in the Australian study had an increased risk of developmental delay after TRH

Answer 59

- set tV 5-7cc/kg - pressure varies with compliance of lung - set pressure limit to avoid accidental overdistension of single lobe - will not work if leak is large - select mode based on infant's ventilatory drive and rate (not significant in helping reduce the risk of BPD)

Answer 60

- injury that sets up BPD is volutrauma, not barotrauma - inadvertent hyperventilation is common - hypocarbia is bad for the brain and lungs - adult type volume controlled ventilation doesnt work well in babes

Answer 61

- same or lower PIP - more stable tV - less hypocapnia - less overexpansion - faster recovery from forced exhalation episodes - works better with AC than SIMV - faster recovery from suctioning - pro inflammatory cytokines decreased at 5mL/kg - faster weaning from mechanical vent - higher tV needed with advanced post natal age

Answer 62

the ventilator servo controls PIP within preset limits to achieve the target tV. In this fashion, the ventilator automatically compensates for changes in lung mechanics and fluctuations in spontaneous respiratory effort to maintain the set tV

Answer 63

low levels of endogenous glucocorticoids in infants that progress to BPD

Answer 64

inflammation begins early in RDS and early glucocorticoids alter this so that progression to BPD is reduced

Answer 65

suggests a trend for improved mortality, decreased vent courses and lower BPD; but none were significantly significant

Answer 66

selective pulmonary vasodilator that reduces VQ mismatch thus reducing ventilator and oxygen requirements - animal models suggest a reduction in pulmonary inflammatory markers and decreased artery remodeling

Answer 67

- showed a trend in favoring reduction of BPD at 28d - decreased mortality - decreased grade III/IV IVH - decreased stage IV ROP

Answer 68

1) need very long itime (to distribute gas to areas of atelectatic alveoli and even longer for the gas to get out- think air trapping) in airways with increased resistance 2) instead of a RR of 60 ∆ to RR of 20 with very large peeps; BIG tV (10-15cc/kg) 3) need exhalation to be very long to empty remote, obstructed alveoli

Answer 69

cGMP- specific phosphodiesterase inhibitor - improves alveolar growth - improves lung angeogensis - reduces PPHN

Answer 70

methytxanthine with anti inflammatory and anti-cytokine effects

Answer 71

preserves tissue architecture following PTB and respiratory support

Chronic Lung Disease Flashcards

(97 cards)