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10 Cards in this Set

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What is the pulmonary vascular resistance like before and after birth?
1. Fetus - high pulm vascular resistance.
. At birth - pulm vascular resistance drops in response to lung inflation and oxygenation
What can increase pulmonary vascular resistance?
Hypoxia
Acidosis
How does the pulmonary and systemic pressure compare in PPHN?
pulmonary arterial pressure equals or exceeds systemic pressure.
What can cause PPHN?
1.Pulmonary vasoconstriction in response to hyoxia and acidosis.
2.Excessive muscularizatin of the pulmonary vessels in utero.
3.Decreased cross-sectional area of the pulmonary vascular bed
4.Decreased flow from increased viscosity or reduced cardiac output
How does PPHN usually presents?
1.Usually presents at or soon after birth
2. Mainly in term and post term infants
3.A/W asphyxia, mec aspiration, pna, shock, IDM, exposure to drugs, polycythemia, diaphragmatic hernia
What do you need to r/o when you suspect PPHN?
Congenital heart disease
How can you diagnose PPHN?
-Echocardiogram
A right to left shunt through the ductus in the presence of normal systemic pressure.
How can you treat PPHN?
1.Avoid hypoxemia, increase FiO2 to 1 (oxygen is a vasodilator)
2.Keep PaCO2 4050.
3.Avoid acidosis. (ph 7.35-7.45)
4.Maintain systemic pressure in the mid to high range of normal (5s) with volume expansion and dopamine.
5.Nitric Oxide
What should you start NO at?
20 ppm
When can you start to wean NO?
-PaO2 >60, sats >90%