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1
Q

Indications for BLES

A
  • FIO2 > .4 on PEEP> 5 to maintain SPo2 >90%

- can redose @ 4hrs

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2
Q

Mech vent calculation

A

VE: ped 100-200, neo 200-300
VT: ped 6-8 ml/kg, 4-6 ml/kg

VE/VT= RR
60sec/RR = TCT
TCT/3 = I:E 1:2
TCT/2 = I:E 1:1 (common in neos)
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3
Q

upper limit of PIP/PLat in neo

A

25cmH20

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4
Q

TTN pulmonary edema mechanism

A
  • mechanical expulsion of fluid
  • catecholamine release from labour
  • may be depressed from induction agents from GA = less cry
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5
Q

potent pulmonary vasodilator

A
  • oxygen ( max 50% ish, SPO2 > 90 PAO2 50-70)

- nitric oxide

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6
Q

Vent target for PPHN

A

PIP < 25
PEEP 4-5
Rate - 40ish

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7
Q

SPO2 targets PPHN

A

pre- 90

post- > 70

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8
Q

Goals of PPNH tx

A

1- surfactant (RDS) (MAS/pneum)
2- correct acidosis as it causes vasoconstriction (inotropes (dob, vasopressin), possibly bicarb)
3- O2 vasodilator
4- ABX
5- decrease PVR with sedation (morph, fent) or paralysis, or pharmacologically with milrinone (inotrope, PVR reduction and lucitropy (cardiac relaxation), prostin (offload RV by maintaining duct latency, also a pulmonary vasodilator)
6- start dobutamine in conjunction with initiation of nitric 20mcg/kg/min
7- adequate ventilation 8-9ribs of inflation, peep 5-8, 4-6 ml/kg, permissive CO2
**consider sidenofil

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9
Q

caution of NO initiation

A

LV over load as its not used to increase preload from RV ie start dobutamine (start @ 5mcg/kg/min)

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10
Q

effects of PPHN on CVS

A

high PVR> RV dysfunction> v/q, decreased LV preload= LV dysfunction

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11
Q

how much O2 should you give in PPHN

A

fi02 > 50 shows no benefit in maximizing pulmonary vasodilation (Pa02 50-70)

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12
Q

mechanism of NO

A

increases cAMP = increased calcium causing dilation

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13
Q

NO complication

A

hypotension, pulmonary haemorrhage ( secondary to intact sunt), Methemoglobinemia, platelet dysfunction,

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14
Q

dosing of NO

A

start at 20 PPM, wean 3-5mcg/min

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15
Q

Big heart on CXR?

A

Auscultate head look for AVM. Especially if pt has low O2 requirement

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16
Q

Pulmonary interstitial emphysema

A

Air leak secondary to rupture of an overdistended alveolus. Overdistention may be due to generalized air trapping or uneven distribution of gas. The air dissects along the perivascular connective tissue sheath toward the hilum, resulting in a pneumomediastinum, or into the pleural space, producing a pneumothorax

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17
Q

type 2 pneumocytes

A

5% on pneumocytes. produces surfactant

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18
Q

effects of surfactant

A
  • protects from collapse (surfactant gets closer together when alveoli are smaller, and become more effective, resulting in less volume required to keep alveoli open
  • protects from over-distension (
  • increases compliance
  • established FRC
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19
Q

what is MIST

A

minimally invasive surfactant therapy ( laryngoscope to visually surfactant by OG while baby is on nasal CPAP)

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20
Q

diaphragmatic hernia goals

A

intubate
ng
avoid PPV (use t piece with PPV less than 25cmh20)
heavy sedation

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21
Q

1-2 kg un-cuffed tube size

A

3

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22
Q

< 1kg un-cuffed tube size

A

2.5

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23
Q

> 2kg un-cuffed tube size

A

3.5

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24
Q

acceptable leak for volume ventilation

A

< 40%

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25
BLES dose
5ml/kg broken into 2 doses
26
rough ETT depth
tip of nose to tegus + 1 OR 3 X tube size
27
TFI in healthy pre-term
high side of normal ie 80ml/kg/day on day 1
28
what to consider when deciding how many lumens to use on UV
- how much fluid you need to utalize as each lumen requires at leas .5ml/hr for patency
29
how to hepranize a line
1ml (1 unit) in 100ml
30
what solution is used for UA
hepranized 1/2NS
31
anatomical dead space in anyone
2ml/kg
32
what type of flow does HFJV utilize
transitional flow
33
how does the HFJV avoid truculent flow
short Ti (.02)
34
how can ventilation reach the distal alvoli
fast high pressure jet that doesn't have to fill dead space to inflate alvoli
35
how does HFJV clear secreations
expiratory flow circles the inspiratory flow almost sweeping secretions along the boarders of airway parenchyma
36
what type of ventilator isn't ideal for cardiac patents
oscillator due to the active insp and exp causing airway collapse in inspected intrathoracic pressure
37
6 candidates for HFJV
- PIE and PALs ( air flow moves past large spaces) - BPD / gas trapping - non-homogeneous lung disease )MAS (also helps clear secretions)/ bronchiolitis) - CDH/ pulmonary hypoplasia - hemodynamic instability (lower Mean airway pressure) - prem with RDS
38
key points of transitioning to CMV from jet
- higher PEEP - Higher rate - smaller volume - try to meet Mean airway pressure or higher (typically 2 cmh2o higher) - consider paralysis and more sedation
39
how do you transition from jet to Ti
2-3 cmh2o greater than MAP on jet
40
how do you transition from oscillator to Ti
1/2 the MAP noted on oscillator
41
RSV
cytopathological response destruction of endothelium conducting airways, when airways repair, they lack cilia and have extra goblet cells which causes large amounts of secretions causing a restrictive pathology (poor compliance). Epithelium takes roughly 2 wks to repair - TX: Humidification!!!, O2 = High flow Dx: RUL consolidation
42
Resistance issues
asthma, bronchiolitis, airway abnormalities, croup, epiglottitis
43
compliance issues
atelectasis/consolidation, bronchiolitis, aspiration/ fact viral pneumonia, pARDS, CHF
44
when is an uncuffed tube used
croup on peds and neonates. this is because the trachea is an oval therefore causing leaks and damage
45
what is the occluding pressure on tracheal capillaries in peds
roughly 15cmH2O
46
ETT size formula
uncuffed age/4 +4 | cuffed age/4 + 3.5
47
what is in indication for exhibition in croup
cuff leak
48
what is the ETT depth formula
tube size x 3
49
suction tube size formula
ETT x 2
50
suction depth formula
ETT X 3 match arrow on tube with number on suction, then note what colour is in the window ***caution in cut tubes
51
viral infection
croup
52
bacterial infection
epiglottitis
53
benefit of PC over pRVC
you can control the pressure in PC vs pRVC will increase pressure to achieve the targeted volume
54
why does NICU target lower vent values
because they are typically managing undeveopled alveoli due to immaturity
55
confirming a tube
- between clavicles and carina - T2-3 - 1-cm above carina
56
potential cause of gasping in an asthmatic patient on NIV
air trapping | - try to match intrinsic peep, as pt has to create a peep lower than the set peep to trigger the vent
57
classic cause of R upper lobe consolidation
Brochoilitis
58
when does the respiratory centre mature
35ish wks
59
alveoli number in infants vs adults
20 milll @ birth vs 300 mill in adult
60
size of alveoli in newborn vs adult
150-180 microM @ birth vs 240-300 microM in adult
61
infant chest wall compliance results in
- less opposition to elastic recoil of lungs - FRC low, which reach closing volume (peripheral alveoli closure) at end of expiration causing atelectasis with normal tidal volumes
62
most common age for bronchiolitis
< 2yrs
63
brochiolitis
- typical < 12m - viral (RSV, rhino/enertovirus) - pathological airway edema increased mucous - CXR: hyperinflation with bilat shifting atelectasis (worsening compliance) (common in RUL @ beginning) - HFNC/BiPAP ( PEEP will ensure closing volumes don't reach FRC) , ABX, gluc,
64
common causes of pneumonia based on age
neo: group B, E.coli, gram - inf: RSV, chlamydia, adenovirus Todd: Pneumoccoccus, Group A, viral Adolecent: All + legionella, gram - Aspiration: staph, step, anaerobes
65
asthma management
salbutamol neb, predisone (1mg/kg) Q12, methylpednisone (1mg/kg) Q 6 OR Hydrocortisone (4mg/kg) Q 4-6hrs IV Mg, Aminophyllin (cannot be used with erythromycin= toxicity) , IV salbutamol ( indication is a pt who doesn't become tachycardia regardless of lots of ventolin neb), BiPAP **all targeted to buy time until steroid works
66
OI
oi= mapa FiO2
67
why are peds more susceptible to resp failure
< 8 closing pressure is greater than FRC

ITT (17 decks)

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