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Pediatrics > RDS and BPD > Flashcards

RDS and BPD Flashcards

1
Q

When is prophylactic surfactant administered?

A

administered after initial stabilization about around 15 minutes after birth

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2
Q

When is rescue surfactant administered?

A

When clinical signs and symptoms of RDS are present and surfactant indications are met

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3
Q

What evidence supports redosing surfactant?

A

shown to improve oxygenation, decrease ventilatory requirements, and decrease risks of air leaks

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4
Q

How is surfactant administered?

A
  1. ETT
  2. LMA
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5
Q

How is surfactant dosed?

A

manufacturer specific, 75-100 mg/kg

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6
Q

How should the infant be positioned for surfactant replacement therapy?

A

Rotate infant to have the side being administered be down, rapidly deliver surfactant, wait ten seconds, rotate sides and repeat

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7
Q

What are the indications for surfactant replacement therapy?

A
  1. RDS
  2. Pulmonary hemorrhage
  3. meconium aspiration syndrome
  4. PNA and sepsis
  5. Congenital diaphragmatic hernia MAYBE
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8
Q

What are complications associated with surfactant delivery?

A
  1. transient airway obstruction
  2. hypoxia
  3. bradycardia
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9
Q

Define respiratory distress syndrome

A

severe impairment of respiratory function due to a decrease in surfactant production which causes low alveolar compliance

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10
Q

what is the primary etiology of RDS?

A

underdevelopment of the lung related to prematurity

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11
Q

Describe the pathophysiology of RDS

A
  1. Surfactant deficiency
  2. Decreased surface area for gas exchange
  3. Thick AC membrane
  4. Overly compliant chest wall
  5. Under developed vascularization
  6. Pulmonary edema
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12
Q

How does RDS present?

A
  1. Respiratory distress within minutes or hours after birth
  2. Apnea, tachycardia, nasal flaring, grunting, intercostal and subcostal retractions, cyanosis, bradycardia, hypoxemia
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13
Q

What does the CXR of an infant with RDS look like?

A
  1. reticulogranular pattern
  2. rough grainy appearing lung tissue
  3. ground glass
  4. peripheral air bronchograms
  5. Alveolar collapse-low lung volumes
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14
Q

How is RDS managed?

A
  1. Prevention of premature delivery
  2. corticosteroids
  3. Proper delivery room management
  4. surfactant replacement therapy
  5. Respiratory support as needed
  6. Mechanical ventilation
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15
Q

What are infants with RDS at increased risk for?

A

air leak syndromes

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16
Q

What can RDS develop into?

A

Bronchopulmonary dysplasia

17
Q

What characterized the “old BPD”?

A
  1. Airway injury due to mechanical ventilation
  2. Volutrauma, barotrauma, atelectrauma and oxygen toxicity
18
Q

What characterizes the “new BPD”?

A

arrest of lung development

19
Q

What are the 7 P’s of bronchopulmonary displacia?

A
  1. Prematurity
  2. Positive pressure ventilation
  3. Prolonged O2 exposure
  4. Protracted use of ETT
  5. Pulmonary edema
  6. Pulmonary air leak
  7. Proinflammatory cascade
20
Q

Describe the pathology of the alveoli in BPD

A
  1. Decreased septation and alveolar hypoplasia
  2. Fewer and larger alveoli
  3. Decreased surface area for gas exchange
21
Q

Describe the pathology of the vasculature in BPD

A
  1. Dysregulation of pulmonary vasculature development
  2. Thickened layer of pulmonary arterioles
  3. Increased PVR
22
Q

Describe the pathology of the interstitial tissue in BPD

A
  1. Increased elastic tissue formation and thickened interstitium
23
Q

How does decreased septation and alveolar hypoplasia affect pulmonary function?

A

Decreases area for gas exchange

24
Q

How does dysregulation of pulmonary vasculature development affect pulmonary function?

A

Increases PVR

25
Q

How does the thickening of elastic tissue formation and thickening in the interstitial tissue affect pulmonary function?

A

Further compromises septation and capillary development

26
Q

How does BPD present?

A
  1. Deteriorating lung function and increased ventilatory requirements and oxygen requirements
27
Q

How is BPD managed?

A
  1. Managed via prevention
  2. Systemic steroids
  3. Diuretic therapy
  4. Inhaled bronchodilators
  5. Optimization of nutrition
28
Q

Suggest ventilator settings for a patient with BPD

A

High VT: 8-12 ml/kg
Low RR: 10-20 bpm
PIP: >25 cm H2O
Prolonged Ti: >0.6

29
Q

What pulmonary complications are associated with BPD?

A
  1. Airway obstruction
  2. Tracheomalacia/bronchomalacia
  3. Pulmonary hypertension
30
Q

T/F: Once a child recovers from BPD, they will not experience re-occuring issues

A

False. 50% of children will require rehospitalization in the first 2 years of life and can experience increases in emergency department visits, systemic corticoid use, antibiotic use, and days with difficulty breathing

Pediatrics (17 decks)

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