Download - Good Morning and Welcome Applicants!
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Good Morning and Welcome Applicants!
January 27, 2011
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Pulmonary HTN• Pulmonary Artery Pressure =
L atrial pressure + (pulm flow x pulm vascular resis)
• Any increase can lead to pulm HTN
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Pulmonary HTN
• Progressive• Pulmonary artery pressure
• >25 mm Hg• Untreated
• RV unable to support circulation• Prognosis determined by
reversibility of underlying process
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PPHN
• Most common cause of PHTN in the newborn• 0.2% of newborns
• Usually associated with respiratory conditions• Elevated pulm vasc resistance• Right to left shunting
• Foramen ovale• Ductus arteriosis
• Significant hypoxemia
• Idiopathic
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PPHN• Presentation
• Profound and labile hypoxemia• Out of proportion to parenchymal disease
• Birth or gradual changes• Cyanosis• Grunting• Flaring• Retractions• Tachypnea• Tachycardia• Shock
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PPHN
• Wide variety of severity• Normal perfusion to shock
• Hypoxemia and acidosis• Further constricts the pulmonary
vessels increasing the PH and creating a cycle
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PPHN
• Shunting• PDA
• Pre and post ductal
• PaO2 gradient of >20 mmHg
• O2 saturation gradient of >5%
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PPHN
• X-rays• Underlying illness• Clear
• Diminished vascular markings
• Slightly dilated heart
• Idiopathic
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PPHN
• Echo• Must exclude cyanotic heart disease• R to L shunting across foramen ovale
or ductus arteriosis• Deviation of the atrial septum
• Ventricular septum• Right atrial enlargement• Tricuspid regurgitation
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PPHN
• Treatment• Underlying disturbances
• Hypoglycemia• Hypocalcemia • Polycythemia• Hypothermia
• Minimal Stimulation
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PPHN
• Treatment• Increase systemic resistance
• Volume• Inotropic • Decrease R to L shunt
• Decrease pulmonary vascular resistance• Oxygen• iNO
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PPHN
• Treatment• Mechanical ventilation• High-frequency ventilation• Sedation• Surfactant • ECMO
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PPHN• Outcomes
• 95% Meconium aspiration• 50% Congenital diaphragmatic hernia
• Neurodevelopmental impairment• Neurosensory hearing loss• Behavioral problems• Respiratory difficulties• Most likely due to the underlying
condition and severity