Page 712 - Clinical Application of Mechanical Ventilation

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in PVR, thus the name of persistent pulmonary hypertension of the newborn
(PPHN). Echocardiography is the best test to confirm PPHN. Following pre- and
Echocardiography is the postductal saturation measurements that may indicate the presence of PPHN with
best test to confirm PPHN. the presence of severe hypoxemia, an echocardiography exam can be performed to
confirm the diagnosis.

Inhaled Nitric Oxide to Treat PPHN. Inhaled nitric oxide therapy is done to lower
Inhaled nitric oxide is
used to treat neonatal pulmo- pulmonary vascular resistance. The walls of the pulmonary arteries are lined with
nary hypertension. endothelial cells that release a substance known as endothelium-derived relaxing
factor (EDRF, which has been identified as inhaled nitric acid). This substance is
responsible for vasodilation in vascular smooth muscle. EDRF has been found to be
an essential link in the transition from fetal to neonatal circulation. Because iNO
dilates the pulmonary arteries, it decreases the pulmonary vascular resistance and its
associated hypertension. Once the pulmonary vessels are dilated, this change should
improve the patient’s pulmonary circulation, V/Q ratio, and oxygenation status.

CASE 15: HOME CARE AND

DISEASE MANAGEMENT

INTRODuCTION

F.W. was a 66-year-old moderately obese white female weighing 109-Kg (240 lbs).
She was brought to the emergency department by her husband and their 17- year-old
daughter on a Saturday morning because they “couldn’t keep her awake and her
breathing sounded funny.” Upon further questioning, the doctor was told by the patient’s
husband that she had no fever, but did have a productive cough with thick greenish
sputum for the past 5 days. The patient had a history of COPD/asthma, cor pulmonale,
hyponatremia, and hyperkalemia. She had no chest pain, except when coughing, but
did have difficulty breathing when lying down. F.W.’s husband reported that she had
At the onset or no nausea and vomiting, and had not complained of pain other than when coughing.
worsening of dyspnea due
to congestive heart failure Social history revealed that F.W. smoked one pack of cigarettes per day for
or pulmonary congestion,
breathing in an upright 25 years, but quit 10 years ago. She did not drink alcohol. She lived with her
position (orthopnea) reduces spouse of 25 years and their 17-year-old daughter. Two other grown children from
pulmonary congestion and
work of breathing. a previous marriage no longer lived at home.
Indication

Physical assessment revealed an obese white female, lethargic, with central cya-
nosis and in respiratory distress. From the information provided by her husband,
the physician determined that the patient had experienced paroxysmal nocturnal

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