5 Questions
What is the etiology of bronchopulmonary dysplasia (BPD)?
BPD is caused by barotrauma from intubation and mechanical ventilation, oxygen toxicity, and infection
What are the clinical manifestations of BPD?
Dyspnea, tachypnea, airway hyperactivity, oxygen dependence, hypoxemia, hypercarbia, abnormal airway growth, tracheobronchomalacia, subglottic stenosis, increased pulmonary vascular resistance, pulmonary hypertension, cor pulmonale, and congestive heart failure
What is the severity index for BPD?
Classifies BPD as mild, moderate, or severe based on oxygen therapy and/or positive-pressure ventilation requirements
What is the recommended management for BPD?
Preventive treatment includes steroids, surfactant replacement, inhaled nitric oxide, antioxidants, vitamin A, and nasal CPAP. Actual treatment is supportive with endotracheal intubation, mechanical ventilation, diuretics, and goal-directed therapies
What are the anesthetic considerations for a patient with BPD?
Optimizing oxygenation, minimizing airway hyperactivity, normalizing electrolyte abnormalities, using smaller endotracheal tubes, considering laryngeal mask airway, neuraxial techniques, maintaining euvolemia, avoiding nitrous oxide, and allowing extended expiratory time
Study Notes
Etiology of BPD
- Premature birth and low birth weight are significant risk factors for developing bronchopulmonary dysplasia (BPD)
- Prolonged mechanical ventilation, oxygen toxicity, and inflammation contribute to the development of BPD
- Genetics, prenatal and perinatal infection, and growth restriction also play a role in the etiology of BPD
Clinical Manifestations of BPD
- Respiratory distress, tachypnea, and oxygen requirement are common presentations of BPD
- Chest radiographs may show hyperinflation, atelectasis, or interstitial markings
- Patients with BPD may exhibit failure to thrive, fatigue, and developmental delays
Severity Index for BPD
- The National Institutes of Health (NIH) severity index grades BPD as mild, moderate, or severe based on oxygen requirement at 36 weeks postmenstrual age (PMA)
- Mild BPD: breathing room air at 36 weeks PMA
- Moderate BPD: requiring <30% oxygen at 36 weeks PMA
- Severe BPD: requiring ≥30% oxygen at 36 weeks PMA or requiring mechanical ventilation
Management of BPD
- Primary goal is to manage respiratory symptoms and prevent further lung injury
- Oxygen therapy, mechanical ventilation, and surfactant administration may be necessary
- Medications such as bronchodilators, diuretics, and corticosteroids may be prescribed
- Nutrition support, immunizations, and developmental therapy are also important aspects of BPD management
Anesthetic Considerations for BPD
- Patients with BPD require careful preoperative assessment and optimization of respiratory status
- Anesthesia induction and maintenance should be tailored to minimize respiratory depression and avoid bronchospasm
- Postoperative pain management should prioritize non-opioid medications to reduce respiratory depression risk
Test your knowledge on bronchopulmonary dysplasia (BPD) with this quiz. Learn about the risk factors, symptoms, and treatment options for this chronic lung disease commonly found in preterm neonates. Identify the key terms, such as oxygen toxicity and respiratory distress syndrome, associated with BPD.
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