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Paediatric Interventions > Normal Cardiopulmonary Development > Flashcards

Normal Cardiopulmonary Development Flashcards

1
Q

What are the 4 sequential stages of prenatal lung development?

A
  • Embryonic period
  • Pseudoglandular period
  • Cannicular period
  • Terminal sac period: Saccular phase, alveolar phase
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2
Q

How do the lungs develop during the embryonic period?

A
  • First 5 weeks after conception
  • Primitive lung buds
  • Main & lobar bronchi formed
  • Pulmonary arteries follow airways & divide as airways divide
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3
Q

How do the lungs develop during the pseudoglandular phase?

A
  • 5-16 weeks gestation
  • Mucous glands are formed, increase in number
  • Muscle fibres, elastic tissue & early cartilage formation
  • Tracheobronchial tree established
  • Diaphragm develops
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4
Q

How do the lungs develop during the cannicular phase?

A
  • 13-25 weeks gestation
  • Rapid proliferation of pulmonary capillary bed
  • Increase in surface of respiratory epithelium
  • Formation of alveolar buds
  • Type I & II pneumocytes (type II site of storage & synthesis of surfactant)
  • After this phase supported extra uterine life becomes possible
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5
Q

When does supported extra uterine life become possible?

A
  • After cannicular phase
  • Approx 32 weeks
  • Enough surfactant to inflate lungs fully for first breath
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6
Q

How do the lungs develop during the terminal sac period?

A
  • 24 weeks to birth
  • Cilia begin to develop
  • Saccular phase: Alveolar buds become saccules, decreased interstitial tissue, cough & gag reflex develop
  • Alveolar phase: Adult number of alveoli achieved around 8 years
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7
Q

What is lung development influenced by?

A
  • Hormones
  • Growth factors
  • Extracellular matrix interactions involved in regulating development (proteins)
  • Corticosteroids & thyroid hormone accelerate lung development
  • Distension of the lung during the final phase of development is also thought to be important
  • Development is not complete until approx 8 years
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8
Q

What is the general overview of cardiac development?

A
  • Precedes other systems
  • Mesodermal tissues that become the heart evident from week 3
  • Continuous with brain & observable pericardial sac
  • As tube increases in size, it becomes central in location & Y shaped
  • Chambers form
  • Heart beats at day 22-23
  • Blood flows at week 4
  • Original paired cardiac tubes fuse
  • Cardiac tube changes to S shape
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9
Q

What causes the cardiac tube to change to an S shape?

A
  • Ventricles originally located superior to atria
  • Ventricles rotate downward, pushing atria upwards
  • Followed by septation (conversion of simple tube into 4 chambered heart)
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10
Q

What is involved in foetal cardiac function?

A
  • Oxygenation of foetus via the placenta.
  • Blood flows within the foetus through right & left sides of the heart in parallel
  • Cardiac output is a function of both ventricles
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11
Q

Where are the two points of cardiac shunting?

A
  • Foramen ovale: Right to left atria (i.e. bypassing lungs)

- Ductus arteriosus: LV & RV

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12
Q

What happens when placental blood flow is interrupted at birth?

A
  • Increased CO2, decreased SaO2
  • Infant inspires
  • Increase blood flow to the lungs
  • Increased blood returns from the lungs into the left atrium
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13
Q

What happens to atrial pressure at birth?

A
  • Pressure increases in left atrium
  • Forces flap covering the foramen ovale closed
  • Blocks communication between left & right atrium
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14
Q

What happens to the ductus arteriosus at birth?

A

Closes almost immediately after birth due to muscular contraction

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15
Q

What are some of the cardiac abnormalities that only become apparent at birth?

A
  • Patent Ductus Arteriosus (PDA)
  • Coarctation of the aorta
  • Atrial septal defect (ASD)
  • Ventricular septal defect (VSD)
  • Tetrology of Fallot
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16
Q

What are the differences between children and adults in the upper respiratory tract?

A
  • Head larger
  • Neck shorter
  • Tongue is large
  • Lack of hair leads to increased heat loss
  • Preferential nose breathers up to 3-4 months of age
  • Nostrils are smaller and easily obstructed
  • Heart, adenoids & tonsils are large
  • Crico-thyroid membrane narrow and vulnerable to open suction & intubation until 7 years of age
17
Q

What are the differences between children and adults in the lower respiratory tract?

A
  • Lungs less compliant
  • Horizontal ribs
  • Less space for lung tissue
  • Weak intercostals
  • Diaphragm fatigues easily
  • Bronchial wall structure different
  • Smaller diameter airways
  • Fewer alveoli (decreased surface area for gas exchange)
  • Collateral channels poorly developed until 2-3 years
  • Lungs don’t reach edge of rib cage until 8 years
18
Q

How does the difference in rib structure affect children?

A

Horizontal ribs

  • No bucket handle mechanism
  • Unable to increase lung volume when distressed
  • Increased RR when distressed
  • Develops during first 2 years
19
Q

What can diaphragm excursion cause in children?

A

Subcostal retraction rather than rib elevation

20
Q

What are the consequences of smaller diameter airways in children?

A
  • High airflow resistance
  • Muscosal oedema can increase WOB
  • Endotracheal tube uncured to minimise airway trauma
21
Q

What are the physiological differences of the respiratory system between children and adults?

A
  • Increased resting metabolic rate & O2 demand
  • Hypoxia causes bradycardia
  • Less reliable cough reflex & poorly developed abs to assist force generation
  • Closing volume > FRC in small infants especially when asleep
22
Q

How is oxygen consumption different in infants and young children?

A
  • Higher than adults
  • Metabolic cost of respiration is higher & may reach 15% of total O2 consumption
  • O2 desaturation occurs quickly
23
Q

How is ventilation & perfusion different in children?

A
  • In adults, ventilation & perfusion distributed to dependent areas first
  • In children, the uppermost areas of the lung are better ventilated & lowermost are better perfused
  • Leads to an increased V/Q mismatch compared with adults
24
Q

What are the signs of respiratory distress in children?

A
  • Nasal flaring
  • Tachypnoea
  • Cyanosis
  • Abnormal breath sounds
  • Pallor
  • Reluctance to feed
  • Stridor
  • Irritability/restlessness
  • Headache
  • Tachycardia/bradycardia
  • Hypertension/hypotension
  • Neck extension
  • Head bobbing
  • Altered conscious level
  • Expiratory grunting
25
Q

What are some of the other factors that can contribute to respiratory distress in children?

A
  • Naive immune systems
  • Dehydrate quickly
  • Immobility
  • Poor historians
  • Co-operation +/-
  • Immature breathing control
26
Q

What are the consequences of an immature respiratory system?

A
  • Predisposed to more serious lung pathologies from simple causes
  • Less protective mechanisms
  • Less efficient than adult system
  • More likely to have alveolar collapse, V/Q mismatch, diaphragm fatigue, desaturation, retained secretions
27
Q

What are wheezes, crackles, stridor and pleural rub on auscultation indications of?

A
  • Wheeze: Spasm or secretions
  • Crackles: Upper airway secretions, interstitial disease, pulmonary oedema
  • Stridor: Laryngeal obstruction, tracheobronchial obstruction, glottic/subglottic anomaly
  • Pleural rub: Pleural friction associated with pleurisy
28
Q

What are the indications for airway clearance in children?

A

Evidence of retained secretions not removed by coughing, turning or suction alone

29
Q

What are the indications not to use airway clearance techniques in children?

A
  • High pitch inspiratory wheeze

- Signs of worsening respiratory distress/failure

30
Q

What are the treatment choices for children?

A
  • Postural drainage and percussion
  • Positioning
  • Expiratory vibes
  • Exercise, walking, breathing games
  • PEP therapy
  • ACBT/FET
  • Humidification/hydration
31
Q

How is suction used in children?

A
  • Guedels & NP airways not used

- Only suction to pharynx

32
Q

What are the precautions for treating children?

A
  • Explain assessment outcomes & treatment goals clearly to parents
  • Treat before a feed or 1-2 hours after
  • Use ventolin or hypertonic saline only after nebuliser or puffer via spacer
  • Have short rest periods between treatment to allow quiet breathing
  • Stop treatment if baby becomes wheezy or distressed
  • Allow for short attention span or refusal of one treatment (have backups)

Paediatric Interventions (27 decks)

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