PATHOPHYSIOLOGY

Neonatal Respiratory Distress Syndrome

PREMATURITY

Surfactant Deficiency

Atelectasis

Structurally Immature Lungs

V/Q Mismatch

Hypoventilation

Hypoxemia & Hypercarbia

Acute Phase

Chronic Phase

Respiratory & Metabolic Acidosis

High Fi02 & Baro or Volutrauma

Pulmonary Vasoconstriction

Inflammation Cell Influx

Antioxidant Release

Impaired Endothelia and Epithelial Integrity

Cytokine Release

Free Radicals

Proteinaceous Exudates

Lung Injury

Respiratory Distress Syndrome (RDS)

Chronic Lung Disease or Bronchopulmonary Dysplasia

Atelectasis - the collapse or closure of the lung resulting in reduced or absent gas exchange. It may affect part or all of one lung. It is a condition where the alveoli are deflated, as distinct from pulmonary consolidation.

the VENTILATION/PERFUSION RATIO (or V/Q ratio) is a measurement used to assess the efficiency and adequacy of the matching of two variables: It is defined as: the ratio of the amount of air reaching the alveoli to the amount of blood reaching the alveoli. "V" ventilation the air that reaches the alveoli "Q" perfusion the blood that reaches the alveoli These two variables constitute the main determinants of the blood oxygen concentration.

Hypoxemia - an abnormally low level of oxygen in the blood. More specifically, it refers to oxygen deficiency in arterial blood. Hypoxemia has many causes, often respiratory disorders, and can cause tissue hypoxia as the blood is not supplying enough oxygen to the body. Hypercarbia - abnormally high level of carbon dioxide in the circulating blood

Respiratory acidosis - is a medical condition in which decreased ventilation (hypoventilation) causes increased blood carbon dioxide concentration and decreased pH (a condition generally called acidosis). Metabolic acidosis - is a condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body.

Fraction of inspired oxygen (FiO2) - is the fraction or percentage of oxygen in the space being measured. Medical patients experiencing difficulty breathing are provided with oxygen-enriched air, which means a higherthan-atmospheric FiO2. Natural air includes 20.9% oxygen, which is equivalent to FiO2 of 0.21. Oxygen-enriched air has a higher FiO2than 0.21, up to 1.00, which means 100% oxygen.[1] FiO2 is typically maintained below 0.5 even with mechanical ventilation, to avoid oxygen toxicity.
Volutrauma - is essentially damage to the lung caused by overdistention by a mechanical ventilator set for an excessively high tidal volume; resulting in a syndrome similar to adult respiratory distress syndrome. Volutrauma is separate from Pulmonary barotrauma because the mechanism of injury is excessive volume (volutrauma), instead of pressure (barotrauma).

Bronchopulmonary dysplasia (BPD - formerly chronic lung disease of infancy) is a chronic lung disorder that is most common among children who were born prematurely. Bronchopulmonary dysplasia results in significant morbidity and mortality. Bronchopulmonary dysplasia is more common in infants with low birth weights and those who received prolonged mechanical ventilation to treat respiratory distress syndrome. The definition of bronchopulmonary dysplasia (BPD) has continued to evolve since 1967 when the disorder was first described in publication, which resulted from effects of oxygen and mechanical ventilation in premature infants with severe respiratory distress syndrome (RDS). This is due to changes in the population at risk.