Page 710 - Clinical Application of Mechanical Ventilation

676 Chapter 19

With the presence of PDA revealed by the echocardiogram, an adequate PaO
2
Insufficient PaO 2 may should be provided and maintained in an attempt to minimize an increase of the
cause hypoxemia and an
increase of the PVR. pulmonary vascular resistance (PVR). Attempts to reduce the F O requirement may
I
2
be successful, but this must be done slowly to prevent the PVR from increasing.

CASE 14: PERSISTENT PULMONARY

HYPERTENSION OF THE NEWBORN

INTRODuCTION

The 5-min Apgar score A 16-year-old primigravida mother gave birth to a 28-week-gestation, 1,130-gm
should show significant
improvement over the one- male infant born without prenatal care. The 1- and 5-min Apgar scores were 3 and
minute score. 5, respectively.

0 1 2 1 min 5 min
Heart rate None Slow Over 100 1 1
Irregular

Respiratory effort Apnea Irregular shallow Yelling, 1 1
Gasping crying

Muscle tone Flaccid Some flexion of Well-flexed 0 1
extremities
Reflex No response Grimace Crying 0 1
to stimulus
Color Pale blue Blue extremities Pink all over 1 1
Body pink
Total 3 5

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Despite an Apgar score of 5 at 5 min, the cardiopulmonary status of the infant
continued to deteriorate and cardiopulmonary resuscitation (CPR) became neces-
Peripheral perfusion
status is a gross indicator sary. CPR was started using 100% oxygen via a flow-inflating resuscitation bag
of cardiac output or tissue
perfusion. with pressure manometer attached. The infant was subsequently intubated with a
2.5 mm endotracheal tube, stabilized and placed on pressure-controlled ventila-
tion without further complications.
An umbilical artery catheter (UAC) was inserted and secured. After a period
of stabilization on the ventilator, the infant still appeared dusky. His capillary refill

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