منقول
RDS (respiratory distress syndrome)
Definition: -
It is a syndrome of respiratory difficulties in newborn infants
caused by a deficiency of a molecule called surfactant.
Grades of respiratory distress syndrome: -
1- Tachypnea
2- retraction
3- granting
4- cyanosis
Tachypnea
Definition:
Tachypnea is increased respiratory rate above 60 c/m.
Normal respiratory rate (30-60 c/m)
Saturation:the amount of oxygen bound to hemoglobin in
the blood, expressed as a percentage of the maximal binding
capacity.
TTN (transient tachypnea of newborn): self-limited
elevation of respiratory rate in newborn due to delayed
clearing of fetal lung water. (wet lung)
الطفل يقوم ب) 30_60 )نفس فى الدقيقة لكى يعمل على تغذية الجسم
باالكسجين الكافى حتى يصل الى نسبه saturation الطبيعيه %98%-92 .
بينما في حاالت الRDS المعدل الطبيعي للتنفس )60-30 )يكون غير كافي لكي
يصل الطفل لمعدل ال saturation الطبيعي فيعمل الطفل علي زيادة معدل
التنفس 70-80-90 لكي يصل لمعدل الsaturation الطبيعي وهو-%92
.98%
Mechanism of tachypnea:
The amniotic fluid works to protect the infant from trauma,
increase the growth of the infant, facilitate infant movement
and are located inside the lung and with the first breath of the
infant all the fluids are expelled but in tachypnea remain
some.
يعمل السائل حول الجنين في الرحم علي حماية الطفل من الصدمات وزيادة النمو
والمساعده علي الحركه ويوجد سائل داخل الرئه ومع أول نفس يقوم الطفل بطرد
السائل من الرئه ولكن يتبقي البعض منه وهو ما يسبب صعوبه وسرعة في
التنفس.
Causes of transient tachypnea:
1-born before 38 wks.
2- delivered by C-section especially if labor has not already
started
3- born to a mother with diabetes
4- male
Treatment of tachypnea:
العالقه بين نسبة األكسجين ومعدل التنفس عالقه طرديه بشرط أال تزيد نسبة
األكسجين عن 40.%
80c/m from 21%
60c/m from 40%
nasal cannula (1-2 l/h)
1 L/h 30%
2 L/h 40%
Retraction
-Retractions are signs that the infant is working hard to
breath.
-Normally when the infant take breath the diaphragm and the
muscles around ribs create a vacum that pull air into the lung.
But if the infant has trouble in breathing, extra muscles kick
into action and the use of these extra muscles result in
retractions.
Types of retractions:
1- subcostal retraction:
inward movement of the
abdomen just below the rib
cage.
2- intercostal retraction:
inward movement of the
skin between the ribs.
Complication of retraction:
1- muscles fatigue
2- respiratory failure
Treatment of retraction:
Nasal cannula (1-2 L/h) and may using cpap device.
Granting
Definition:
Granting is a deep-pitched gutteral rumble which may be
heard by infants suffering from respiratory distress.
Mechanism of action:
Grunting is a forced expiration against a closed glottis. It is
characteristic of painful and labored breathing and of
expiratory effort.
Causes of granting:
1- wet lung with amniotic fluid
2- meconium aspiration
3- pneumonia
Complications of granting:
1- pneumothorax
2- IVH (intraventricular hemorrhage of newborn)
3- pulmonary hemorrhage
4- retinopathy of prematurity (blindness)
Treatment of the granting:
Definition of cpap:
continuous positive airway
pressure it is a method of
positive pressure ventilation
used with patients who are
breathing spontaneously, done
to keep the alveoli open at the
end of exhalation and thus
increase oxygenation and
reduce the work of breathing.
Parameters of cpap:
Air + oxygen = 8 L/H (60%) Peep = 4-6
بحيث ان معدل االكسجين ال يتعدي 4 لتر في الساعه و لو االكسجين هيبقي اقل
من 4 بنكمل الباقي بالهواء.
1L/h 30%
2L/h 40%
3L/h 50%
4L/h 60%
5L/h 70%
في حالة عدم تحسن الطفل علي أكسجين 60 %نلجأ الستخدام جهاز التنفس
الصناعي (MV).
Cyanosis
Definition:
Cyanosis is a physical sign causing bluish discoloration of the
skin and mucous membranes. Cyanosis is caused by a lack of
oxygen in the blood. Cyanosis is associated with cold
temperatures, heart failure, lung diseases, and smothering. It
is seen in infants at birth because of heart defects, respiratory
distress syndrome, or lung and breathing problems.
Types of cyanosis:
1- central cyanosis: begin at lips then face then all body.
2- acro cyanosis: in the extremities.
Definition of cpap:
continuous positive airway
pressure it is a method of
positive pressure ventilation
used with patients who are
breathing spontaneously, done
to keep the alveoli open at the
end of exhalation and thus
increase oxygenation and
reduce the work of breathing.
Parameters of cpap:
Air + oxygen = 8 L/H (60%) Peep = 4-6
بحيث ان معدل االكسجين ال يتعدي 4 لتر في الساعه و لو االكسجين هيبقي اقل
من 4 بنكمل الباقي بالهواء.
1L/h 30%
2L/h 40%
3L/h 50%
4L/h 60%
5L/h 70%
في حالة عدم تحسن الطفل علي أكسجين 60 %نلجأ الستخدام جهاز التنفس
الصناعي (MV).
Cyanosis
Definition:
Cyanosis is a physical sign causing bluish discoloration of the
skin and mucous membranes. Cyanosis is caused by a lack of
oxygen in the blood. Cyanosis is associated with cold
temperatures, heart failure, lung diseases, and smothering. It
is seen in infants at birth because of heart defects, respiratory
distress syndrome, or lung and breathing problems.
Types of cyanosis:
1- central cyanosis: begin at lips then face then all body.
2- acro cyanosis: in the extremities.
Causes of central cyanosis
acute granting hypothermia
Pneumonia
meconium aspiration
Pneumothorax
Hemothorax
CHD (congenital heart
disease)
Complications of cyanosis:
1- abnormal heart rhythms and sudden death
2- heart failure
3- infection in the heart
4- stroke
5- chronic high blood pressure in the blood vessels of the
lung
acute granting hypothermia
Pneumonia
meconium aspiration
Pneumothorax
Hemothorax
CHD (congenital heart
disease)
Complications of cyanosis:
1- abnormal heart rhythms and sudden death
2- heart failure
3- infection in the heart
4- stroke
5- chronic high blood pressure in the blood vessels of the
lung
Treatment of cyanosis:
By using mechanical ventilator (MV)
Definition of MV:
Mechanical ventilation, in the healthcare setting or home,
helps patients breathe by assisting the
inhalation of oxygen into the lungs and
the exhalation of carbon dioxide.
Depending on the patient’s condition,
mechanical ventilation can help support
or completely control breathing.
By using mechanical ventilator (MV)
Definition of MV:
Mechanical ventilation, in the healthcare setting or home,
helps patients breathe by assisting the
inhalation of oxygen into the lungs and
the exhalation of carbon dioxide.
Depending on the patient’s condition,
mechanical ventilation can help support
or completely control breathing.
Modes of MV:
1- PCV (Pressure-Controlled)
في مود ال pcv يكون جهاز التنفس الصناعي هو المتحكم بشكل كلي في
عملية التنفس والطفل ال يتنفس بنفسه ويكون متخدر عن طريق تخدير وريدي
علي مدار 24 ساعه وعن طريق الshots.
2- SIMV (Synchronized intermittent mandatory
ventilation)
في مود simv جهاز التنفس الصناعي ال يتحكم كليا في عملية التنفس لكن
الطفل مثال يقوم بعملية الشهيق وال يستطيع القيام بعملية الزفير فيقوم الجهاز
باستكمال عملية التنفس. أو ان الطفل يستطيع القيام بعمليه الشهيق والزفير
ولكن بعدد قليل غير كافي فيقوم الجهاز بزيادة العدد.
الحاله بتبقي متخدره عن طريق ال shots فقط.
Parameters of MV:
1- FIO2: 21-100%
Definition:The
measure of oxygen
the ventilator is
delivering during
inspiration.
2- RR: 30-60 c/m
Definition:The
number of breaths
delivered by the ventilator per minute.
3- PIP (Peak inspiratory pressure): (N 10-24)
Definition:
The flow of gas/air (flow rate) used to deliver each
mechanical breath to the patient
الضغط المستخدم عند اعطاء الطفل الغازات ) هواء – اكسجين ( اثناء عملية
الشهيق
أقصي ضغط ممكن اوصله هوعمر الحاله باالسابيع فى حاالت :
white lung in full term.
4- PEEP (Positive end-expiratory pressure): (N4-6)
Definition:
Mechanical positive pressure is applied at the end of
exhalation to prevent the lungs from emptying completely
and returning to a “zero” reading. The benefit of positive
pressure at the end of exhalation is increased lung volume
for improved oxygenation.
الجزء المتبقي من الضغط داخل الرئه بعد عملية الزفير لكى يحافظ على الرئه
مفتوحة وتحسين عملية التنفس.
1- PCV (Pressure-Controlled)
في مود ال pcv يكون جهاز التنفس الصناعي هو المتحكم بشكل كلي في
عملية التنفس والطفل ال يتنفس بنفسه ويكون متخدر عن طريق تخدير وريدي
علي مدار 24 ساعه وعن طريق الshots.
2- SIMV (Synchronized intermittent mandatory
ventilation)
في مود simv جهاز التنفس الصناعي ال يتحكم كليا في عملية التنفس لكن
الطفل مثال يقوم بعملية الشهيق وال يستطيع القيام بعملية الزفير فيقوم الجهاز
باستكمال عملية التنفس. أو ان الطفل يستطيع القيام بعمليه الشهيق والزفير
ولكن بعدد قليل غير كافي فيقوم الجهاز بزيادة العدد.
الحاله بتبقي متخدره عن طريق ال shots فقط.
Parameters of MV:
1- FIO2: 21-100%
Definition:The
measure of oxygen
the ventilator is
delivering during
inspiration.
2- RR: 30-60 c/m
Definition:The
number of breaths
delivered by the ventilator per minute.
3- PIP (Peak inspiratory pressure): (N 10-24)
Definition:
The flow of gas/air (flow rate) used to deliver each
mechanical breath to the patient
الضغط المستخدم عند اعطاء الطفل الغازات ) هواء – اكسجين ( اثناء عملية
الشهيق
أقصي ضغط ممكن اوصله هوعمر الحاله باالسابيع فى حاالت :
white lung in full term.
4- PEEP (Positive end-expiratory pressure): (N4-6)
Definition:
Mechanical positive pressure is applied at the end of
exhalation to prevent the lungs from emptying completely
and returning to a “zero” reading. The benefit of positive
pressure at the end of exhalation is increased lung volume
for improved oxygenation.
الجزء المتبقي من الضغط داخل الرئه بعد عملية الزفير لكى يحافظ على الرئه
مفتوحة وتحسين عملية التنفس.
