Bronchopulmonary dysplasia - NYSORA

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Bronchopulmonary dysplasia

Bronchopulmonary dysplasia

Learning objectives

  • Describe bronchopulmonary dysplasia
  • Understand the pathophysiology of bronchopulmonary dysplasia
  • Recognize the risk factors for developing bronchopulmonary dysplasia
  • Anesthetic management of a pediatric patient with bronchopulmonary dysplasia

Definition and mechanisms

  • Bronchopulmonary dysplasia (BPD) is a chronic lung disease in which premature infants require long-term oxygen because the alveoli that are present, are not mature enough to function properly
  • Babies are not born with BPD, the condition results from damage to the lungs, usually caused by mechanical ventilation and long-term use of oxygen
  • BPD is more common in infants with a low birth weight and those who receive prolonged mechanical ventilation to treat respiratory distress syndrome
  • BPD develops most commonly in the first 4 weeks after birth
Criteria for BPD diagnosis
Infants requiring supplemental oxygen at 28 days are diagnosed, via an assessment at 36 weeks postmenstrual age, as having:
Mild BPDInfant breathing room air
Moderate BPDInfant requiring <30% FiO2
Severe BPDInfant requiring >30% FiO2 or positive pressure ventilation

Signs and symptoms

  • Hypoxemia
  • Hypercapnia
  • Crackles, wheezing, and decreased breath sounds
  • Increased bronchial secretions
  • Hyperinflation
  • Feeding problems due to prolonged intubation (oral-tactile hypersensitivity/oral aversion)
  • Need for continued oxygen therapy after the gestational age of 36 weeks
  • Repeated lower respiratory infections that may require hospitalization
  • Delayed growth and development

Causes

bronchopulmonary dysplasia, BPD, oxygen, premature, necrotizing bronchiolitis, alveolar septal injury, inflammation, scarring, hypoxemia

Risk factors

Complications

  • Airway disease and respiratory morbidity due to prolonged tracheal intubation and mechanical ventilation
    • Development of tracheomalacia and bronchomalacia
    • BPD spells: Acute cyanotic events caused by increases in central airway compliance
    • Subglottic stenosis
    • Airway granulomas
    • Pseudopolyps
    • Persistent airway obstruction and hyperreactivity
  • Pulmonary hypertension
  • Cor pulmonale

Pathophysiology

bronchopulmonary dysplasia, BPD, pathophysiology, lungs, proinflammatory cytokines, pulmonary vascular resistance, remodelling, pulmonary hypertension, hypoxia, retractions, wheezing, crackles, respiratory distress, interstitial fibrosis, obstructive lung disease

Treatment

  • There is no cure for BPD, treatment focuses on minimizing further lung damage and providing support for the infant’s lungs
  • Oxygen therapy
    • Nasal continuous positive airway pressure (NCPAP)
    • Bilevel positive airway pressure (BiPAP)
  • Medications
    • Diuretics: Decrease fluid in and around the alveoli
    • Bronchodilators: Relax the muscles around the air passages, widening the airway openings and making breathing easier
    • Corticosteroids: Reduce and/or prevent inflammation within the lungs, reduce swelling in the trachea, and decrease the mucus production
    • Viral immunization: Prevent infection (i.e., respiratory syncytial virus)

Management

bronchopulmonary dysplasia, BPD, preoperative, postoperative, management, preanesthetic evaluation, preanesthetic preparation, preoperative history, physical examination, pulmonary hypertension, right ventricular dysfunction, ECG, echocardiography, oxygen, bronchospasm, steroid, infection, diuretics, midazolam, opioid, mechanical ventilation, CPAP

bronchopulmonary dysplasia, BPD, intraoperative, management, induction, neuromuscular blocking drugs, anesthetic management, intravenous induction, etomidate, thiopental, ketamine, propofol, inhalational induction, sevoflurane, acetylcholinesterase inhibitor, bronchospasm, pulmonary vascular resistance, cardiac contractility, asthma, oxygen, pulmonary hypertension, cor pulmonale, laryngeal mask airway, tracheal intubation, deep anesthesia, glycopyrrolate, atropine, cuffed tracheal tubes, regional anesthesia

Prevention

  • Antenatal steroid administration
  • Surfactant therapy
  • Improved ventilator strategies to minimize lung injury

Keep in mind

Suggested reading

  • Lauer R, Vadi M, Mason L. Anaesthetic management of the child with co-existing pulmonary disease. BJA. 2012;109(1):i47-i59.

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