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1 
Fisiología Pulmonar 
Neonatal 
Dr. Mario Herrera Castellanos 
Pediatra Neonatólogo
Sistema Respiratorio Fetal 
• En el feto los pulmones están llenos 
de líquido y no tienen función 
respiratoria. 
• Pero ...
Desarrollo 
pulmonar 
Week 4 – 5 Embryonic 
Week 5 - 17 Pseudoglandular 
Week 16 - 25 Canalicular 
Week 24 - 40 Terminal s...
Sistema Respiratorio Fetal 
• Crecimiento pulmonar: Balance 
Producción/drenaje del LP 
• Balance alterado: 
– Obstrucción...
Sistema Respiratorio Fetal 
• Los compartimientos de fluidos del 
pulmón fetal son 
– la microcirculación 
– el interstici...
Transporte activo de cloro 
• Transporte por gradiente osmótico 
• Transporte activo 
– La producción aumenta de 6 a 20 ml...
Resistencia vascular 
pulmonar 
• Resistencia pasiva 
• Presión hidrostática 
• Resistencia activa 
– Baja tensión de oxíg...
De la respiración “líquida” a 
la respiración gaseosa 
• Cese del contenido H20 al nacer 
• Catecolaminas 
• Hormonas, neu...
Tres etapas 
• Fetal 
• Transicional 
• Postnatal 
– Efecto de los canales y Transporte 
activo de Sodio
Depuración líquido alveolar 
• Adrenérgicos β/catecolaminas 
• Arginina vasopresina 
• PGE2 
• Prolactina 
• Surfactante 
...
Causas de retraso en 
absorción H20 
• Insuficiencia de la disminución 
prenatal de líquido pulmonar fetal: 
• Nacimiento ...
Causas de retraso en 
absorción H20 
• Disminución del transporte epitelial 
de sodio y agua: 
• Reducción del número y fu...
Paso a respiración tipo 
adulto 
• Compresión del trabajo de parto 
• Expansión de tórax 
• Aumento de la Pa02 
– Hb FETAL...
VT 
VRi 
VRe 
Vres 
Volúmenes y capacidades pulmonares
CPT 
CV 
CFR 
Volúmenes y capacidades pulmonares
Valores en RN 
Vt 6 ml/kg 
EM 2 mL/lg 
CFR 30 mL/kg 
FR 35 r/min 
Vent Min 210 mL/kg/min 
Vent Alv 140 mL/kg/min
Ventilación Alveolar = 
(v. Tidal - espacio muerto)f 
Ventilación Minuto = 
v. Tidal x f
VOLUMEN TIDAL 
• CONSTANTE EN 
VENTILADORES DE VOLUMEN 
• VARIABLE EN VENTILADORES 
DE PRESIÓN 
• DEPENDE EN ESTOS DE : 
C...
C R 
Volumen Tidal 
Ti 
D P
Gradiente de Presión 
Es la diferencia de presión entre la 
presión de apertura de la vía aérea y 
la presión alveolar 
PI...
COMPLACENCIA 
Es la propiedad de elasticidad o 
distensibilidad de los pulmones y la 
pared torácica 
[C] = cambio VOLUMEN...
VOL 
Lts 
0.6 
0.4 
0.2 
0.1 
P cmH20 
0 20 30 40 50 
Curva P/V
RESISTENCIA 
Es una propiedad innata del sistema 
conductor de aire (vía aérea, tubo 
OT), de resistir el flujo de aire 
[...
RESISTENCIA 
Si, ­ PRESION = ­R 
FLUJO 
Si, PRESION = ¯R 
­FLUJO
CONSTANTE DE TIEMPO 
Medida de tiempo expresada en 
segundos, necesaria para permitir 
un 63% de equilibración de P o V, 
...
Constante de Tiempo 
Inspiración Espiración 
120 
100 
80 
60 
40 
20 
0 
0 1 2 3 4 5 1 2 3 4 5 
Constantes de Tiempo 
% e...
CCoonnssttaannttee ddee TTiieemmppoo 
• Toma 3 constantes de tiempo para 
un 95 % de equilibrio 
• 5 constantes de tiempo ...
Curva Flujo/tiempo 
0.5 1 1.5 2 2.5 3 
Seg 
120 
Vol 
L/M 
120 
Ti Te Ti
Curva Flujo/tiempo 
Ti muy prolongado 
0.5 1 1.5 2 2.5 3 
Seg 
120 
Vol 
L/M 
120 
Ti Te
Curva Flujo/tiempo 
Ti muy Corto 
0.5 1 1.5 2 2.5 3 
Seg 
120 
Vol 
L/M 
120 
Ti Te
Valores en RN 
Complacencia del Sist Resp 3 mL/cm H20 
Complacencia pulmonar 4 mL/cm H20 
Complacencia de Caja Toráxica 20...
Determinantes de Volumen 
Tidal 
C O N S T A N T E D E T IE M P O 
R E S IS T E N C IA C O M P L A C E N C IA 
G R A D IE ...
Mantenimiento de la 
Oxigenación 
PUEDE HABER HIPOXEMIA POR:
Fisiologia pulmonar neonatal
Fisiologia pulmonar neonatal
Fisiologia pulmonar neonatal
Fisiologia pulmonar neonatal
Fisiologia pulmonar neonatal
Fisiologia pulmonar neonatal
Fisiologia pulmonar neonatal
Fisiologia pulmonar neonatal
Fisiologia pulmonar neonatal
Fisiologia pulmonar neonatal
Fisiologia pulmonar neonatal
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Fisiologia pulmonar neonatal

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Fisiologia pulmonar neonatal

  1. 1. 1 Fisiología Pulmonar Neonatal Dr. Mario Herrera Castellanos Pediatra Neonatólogo
  2. 2. Sistema Respiratorio Fetal • En el feto los pulmones están llenos de líquido y no tienen función respiratoria. • Pero son metabólicamente activos: – Síntesis de surfactante – Secreción activa de líquido pulmonar al espacio aéreo virtual – Movimientos respiratorios
  3. 3. Desarrollo pulmonar Week 4 – 5 Embryonic Week 5 - 17 Pseudoglandular Week 16 - 25 Canalicular Week 24 - 40 Terminal sac Late fetal - 8 a. Alveolar
  4. 4. Sistema Respiratorio Fetal • Crecimiento pulmonar: Balance Producción/drenaje del LP • Balance alterado: – Obstrucción traqueal – Oclusión arteria pulmonar – Hernia diafragmática – Compresión del tórax (Potter)
  5. 5. Sistema Respiratorio Fetal • Los compartimientos de fluidos del pulmón fetal son – la microcirculación – el intersticio (drenado por los linfáticos a la circulación venosa) – el espacio aéreo potencial
  6. 6. Transporte activo de cloro • Transporte por gradiente osmótico • Transporte activo – La producción aumenta de 6 a 20 ml/kg al final del embarazo (2-5 ml/kg/Hora) – Cese del transporte al nacimiento (los niveles disminuyen a los plasmáticos a los 30 minutos del nacimiento)
  7. 7. Resistencia vascular pulmonar • Resistencia pasiva • Presión hidrostática • Resistencia activa – Baja tensión de oxígeno • Inervación vascular capilar sensible a péptidos vasoconstrictores
  8. 8. De la respiración “líquida” a la respiración gaseosa • Cese del contenido H20 al nacer • Catecolaminas • Hormonas, neuropéptidos • Óxido nítrico • Surfactante • Efecto de compresión tórax ????
  9. 9. Tres etapas • Fetal • Transicional • Postnatal – Efecto de los canales y Transporte activo de Sodio
  10. 10. Depuración líquido alveolar • Adrenérgicos β/catecolaminas • Arginina vasopresina • PGE2 • Prolactina • Surfactante • Oxígeno • Factor de necrosis tumoral α • Factor de crecimiento epidérmico • Papel de los Glucocorticoides
  11. 11. Causas de retraso en absorción H20 • Insuficiencia de la disminución prenatal de líquido pulmonar fetal: • Nacimiento sin trabajo de parto • Factores desconocidos • Producción excesiva de líquido: • Presión intravascular alta (edema cardiogénico – hídrops fetalis) • Incremento de la permeabilidad vascular
  12. 12. Causas de retraso en absorción H20 • Disminución del transporte epitelial de sodio y agua: • Reducción del número y funcionalidad de células tipo II • Disminución de la actividad de los canales de sodio • Disminución de la función de Na - K ATPasa
  13. 13. Paso a respiración tipo adulto • Compresión del trabajo de parto • Expansión de tórax • Aumento de la Pa02 – Hb FETAL • Cambios en vasculatura pulmonar y resistencia periférica • Cambio de circulación fetal a transicional (Ductus A) y tipo adulto
  14. 14. VT VRi VRe Vres Volúmenes y capacidades pulmonares
  15. 15. CPT CV CFR Volúmenes y capacidades pulmonares
  16. 16. Valores en RN Vt 6 ml/kg EM 2 mL/lg CFR 30 mL/kg FR 35 r/min Vent Min 210 mL/kg/min Vent Alv 140 mL/kg/min
  17. 17. Ventilación Alveolar = (v. Tidal - espacio muerto)f Ventilación Minuto = v. Tidal x f
  18. 18. VOLUMEN TIDAL • CONSTANTE EN VENTILADORES DE VOLUMEN • VARIABLE EN VENTILADORES DE PRESIÓN • DEPENDE EN ESTOS DE : COMPLACENCIA, RESISTENCIA, GRADIENTE DE PRESIÓN Y EL Ti
  19. 19. C R Volumen Tidal Ti D P
  20. 20. Gradiente de Presión Es la diferencia de presión entre la presión de apertura de la vía aérea y la presión alveolar PIP - Peep A su vez está determinada por la COMPLACENCIA y la RESISTENCIA
  21. 21. COMPLACENCIA Es la propiedad de elasticidad o distensibilidad de los pulmones y la pared torácica [C] = cambio VOLUMEN cambio PRESION
  22. 22. VOL Lts 0.6 0.4 0.2 0.1 P cmH20 0 20 30 40 50 Curva P/V
  23. 23. RESISTENCIA Es una propiedad innata del sistema conductor de aire (vía aérea, tubo OT), de resistir el flujo de aire [R] = cambio de PRESION cambio de FLUJO
  24. 24. RESISTENCIA Si, ­ PRESION = ­R FLUJO Si, PRESION = ¯R ­FLUJO
  25. 25. CONSTANTE DE TIEMPO Medida de tiempo expresada en segundos, necesaria para permitir un 63% de equilibración de P o V, que ocurre como respuesta a cada cambio de presión de la vía aérea. [Ct] = complacencia x resistencia
  26. 26. Constante de Tiempo Inspiración Espiración 120 100 80 60 40 20 0 0 1 2 3 4 5 1 2 3 4 5 Constantes de Tiempo % equilibrio P ó V P - V Presión o volumen alveolar
  27. 27. CCoonnssttaannttee ddee TTiieemmppoo • Toma 3 constantes de tiempo para un 95 % de equilibrio • 5 constantes de tiempo para el 99 % de equilibrio • Menos de 5 Constantes de tiempo equivale a Tiempos Inspiratorios o espiratorios insuficientes
  28. 28. Curva Flujo/tiempo 0.5 1 1.5 2 2.5 3 Seg 120 Vol L/M 120 Ti Te Ti
  29. 29. Curva Flujo/tiempo Ti muy prolongado 0.5 1 1.5 2 2.5 3 Seg 120 Vol L/M 120 Ti Te
  30. 30. Curva Flujo/tiempo Ti muy Corto 0.5 1 1.5 2 2.5 3 Seg 120 Vol L/M 120 Ti Te
  31. 31. Valores en RN Complacencia del Sist Resp 3 mL/cm H20 Complacencia pulmonar 4 mL/cm H20 Complacencia de Caja Toráxica 20 mL/cm H20 Resistencia Inspiratoria Total 0.069 cm H20/mL/seg Resistencia Espiratoria Total 0.097 cm H20/mL/seg CT inspiratoria 0.2 seg CT Espiratoria 0.3 seg
  32. 32. Determinantes de Volumen Tidal C O N S T A N T E D E T IE M P O R E S IS T E N C IA C O M P L A C E N C IA G R A D IE N T E D E P R E S IO N P IP P E E P T IE M P O IN S P IR A T O R IO F R E C U E N C IA R E S P IR A T O R IA R E L A C IO N I:E V O L U M E N T ID A L
  33. 33. Mantenimiento de la Oxigenación PUEDE HABER HIPOXEMIA POR:

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