Newborn Ventilation.pptVIP

Presentation Information CONFIDENTIAL LUNG MATURATIONFive Stages of Lung Development 1.) EMBRYONIC 2.) PSEUDOGLANDULAR 3.) CANALICULAR 4.) SACCULAR 5.) ALVEOLAR E – ENVIRONMENTAL P – PROTECTION C – CAN S – SAVE A - AMERICA INTRAUTERINE DEVELOPMENT OF THE LUNG EMBRYONIC PHASE 4 TO 6 WEEKS GESTATION LUNG BUD BRANCHES TO RIGHT AND LEFT MAIN STEM BRONCHI AND CONTINUES DOWN TO THE PROXIMAL AIRWAY LEVEL. TRACHEO-ESOPHOGEAL FISTULA CAN OCCUR PSEUDOGLADULAR PHASE 7 TO 16 WEEKS GESTATION CONDUCTING AIRWAYS AND DIAPHRAGM IS FORMED CILIA, GOBLET CELLS, MUCOUS GLANDS RESPIRATORY EPITHELIUM STARTS TO DESIGN DIAPHRAGMATIC HERNIA IS POSSIBLE CANALICULAR PHASE 17 TO 28 WEEKS GESTATION GAS EXCHANGE AREA STARTS TO DEVELOP TYPE I AND TYPE II PNEUMOCYTES APPEAR CAPPILLARIES FORM NEAR THE ALVEOLI ALVEOLAR WALL IS 45 MICRONS THICK AT 20 WEEKS SURFACTANT APPEARS, BUT IS INEFFECTIVE GAS EXHCHANGING COMPONENTS MATURE IN THE LAST TWO PHASES A-C MEMBRANE MAY SUSTAIN EXTRAUTERINE LIFE SACCULAR PHASE 29 TO 35 WEEKS GESTATION LUNG PARENCHYMA SPACES DECREASE AND AIRSPACE WALLS NARROW AIRSPACES DIVIDE INTO SMALLER UNITS NOTE: ALVEOLI APPEAR AT 32 TO 36 WEEKS GESTATION ALVEOLAR PHASE 36 WEEKS TO TERM ALVEOLI DEVELOP AND MATURE (10 TO 150 MILLION) 300 MILLION AT MATURITY (3 YEARS OLD) ALVEOLAR WALL IS 15 MICRONS vs. 1 MICRON IN ADULTS IN THE FETUS, THE HIGHEST PaO2 IS LESS THAN 25mmHg, WITH AN O2 SATURATION OF 60%. DURING THE TRANSITION TO EXTRAUTERINE LIFE, THE PO2 AND O2 SATURATION RISES PROGRESSIVELY AS THE PULMONARY CIRCULATION IS ESTABLISHED AND SYSTEMIC PRESSURE INCREASES. IN OUR NNICU: OXYGEN SATURATION : 85% to 95%! AT THE FLAT TOP PORTION OF THE OXYHEMOGLOBIN DISSOCIATION CURVE, HIGH LEVELS OF PaO2 (60mmHg), THE OXYGEN SATURATION SHOWS LITTLE CORRELATION TO THE INCREASE OF FIO2. FOR EXAMPLE, AN OXYGEN SATURATION OF 98% MAY BE REFLECTING A PaO2 OF 60 OR 150mmHg! HYPOXIC RESPIRATORY FAILURE CAN BE CAUSED