【体外膜肺ECMO精品课件】 Physiologic Basis for the Management of Acute Respiratory Disorders in the Newborn.pptVIP

Left pneumothorax? pneumothorax Transillumination of left pneumothorax pneumomediastinum Pneumopericardium (note air under heart) Air Leaks initiating factor: PIE (alveolar rupture into perivascular and peribronchial spaces) dissection into mediastinum further dissection into pleural, pericardial space rupture from surface blebs direct lung rupture-VERY rare Air Leak Risk Factors RDS: 12-26% MAS/other aspirations Spontaneous Air Leak Management early recognition (esp. in preterms) nitrogen wash-out (term/near-term) needle aspiration v. tube thoracotomy limit barotrauma HFOV positioning selective ET intubation Meconium Aspiration Syndrome (MAS) GI secretions, cellular debris, bile, pancreatic juice, mucus, lanugo hairs, vernix; blood. incidence: ~15% (30% @ 42 wks) cause v. result of ‘asphyxia’ MAS Asphyxia ? intestinal ischemia ? anal sphincter relaxation ? meconium passage MAS Asphyxia ? fetal gasping ? enhanced meconium entry into respiratory tract MAS-Presentation Respiratory distress - tachypnea - prolonged expiratory phase - hypoxemia Increased A-P diameter (‘barrel’ chest) Pulmonary hypertension MAS-Radiographic Findings coarse alveolar infiltrates consolidation/hyperaeration pleural effusion (30%) pneumothorax/pneumomediastinum Physiologic Basis for the Management of Acute Respiratory Disorders in the Newborn Marc Collin, MD 18 November 2003 Developmental Anatomy Alveoli-developed by 25th week -increase in # until 8 yr. -from 20 to 300 million -surface area: 2.8 m2 @ birth 32 m2 @ 8 yr. 75 m2 @ adulthood -diameter: 150- 300 um(NB-Adult) Developmental Anatomy Airways- cartilaginous - relatively weak in infancy - dynamic compress