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Principles I* > E2- Breathing Systems II > Flashcards

E2- Breathing Systems II Flashcards

1
Q

What is a Mapleson Circuit?

A
  • The Mapleson Circuit Systems are used for the delivery of oxygen and anesthetic agents and the removal of carbon dioxide
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2
Q

How many types of Mapleson Circuits are there? Mneumonic?

A
  • Six Types (A → F)
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3
Q

What are the components of the Mapleson Circuit?

A
  • Patient connection/Facemask - Patient end
  • Reservoir bag - operator end
  • Corrugated tubing
  • APL valve - variable positioning
  • Fresh gas inlet - variable positioning
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4
Q

What 3 components are absent in all Mapleson Circuit Systems?

A
  • CO2 absorber
  • Unidirectional Valves
  • Separate Inspiratory and Expiratory Limbs
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5
Q

What are 2 other names for the Mapleson Circuit Systems?

A
  • Carbon Dioxide Washout Circuits
  • Flow-controlled Breathing Systems
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6
Q

How does the Mapleson Circuit System prevent rebreathing without a CO2 absorber?

A
  • FGF must be significantly greater than minute ventilation to “washout” the CO2.
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7
Q

What is another name for Mapleson A?

A
  • Magill’s System
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8
Q

Where does fresh gas flow enter in the Mapleson A circuit?

Where is the APL valve located in the Mapleson A circuit?

A
  • FGF = near reservoir bag
  • APL valve = patient end
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9
Q

Of all the systems, what is Mapleson A best at?

What is Mapleson A the worst at?

A
  • Best efficiency of all systems for spontaneous ventilation
  • Worst efficiency of systems for controlled ventilation
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10
Q

Mapleson A

Spontaneous :: prevent rebreathing?
Controlled ventilation : rebreathing occurs unless Vm greater than ______ ?

A

FGF must be greater than or equal to Vm
20 L/min

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11
Q

Mapleson A Circuit:
What is vented out from the APL valve in spontaneous ventilation during expiration?

A
  • Dead space gas (yellow)
  • Alveolar gas (red)
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12
Q

Mapleson A Circuit:
What is vented out from the APL valve in controlled ventilation during expiration?

A
  • APL valve does not open
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13
Q

Mapleson A Circuit:
What is vented out from the APL valve in controlled ventilation during inspiration?

A
  • Mostly fresh gas (blue)
  • Some alveolar gas (red)
  • Increase the risk of rebreathing alveolar gas (red)
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14
Q

Where are the APL Valve and Fresh gas inlet located in the Mapleson B Circuit?
Where is the reservoir bag?

A
  • APL and FG inlet located near the patient
  • Reservoir bag = end of system
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15
Q

Why is the Mapleson B Circuit considered inefficient and obsolete?

A
  • FGF is vented through APL during exhalation = Inefficient
  • Blue (FGF)
  • Red (alveolar gas)
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16
Q

FGF should be ______ times the minute volume during spontaneous and controlled ventilation to prevent rebreathing in the Mapleson B circuit.

A
  • FGF should be 2x minute volume
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17
Q

Where are the APL Valve and Fresh gas inlet located in the Mapleson C Circuit?

A
  • APL and FGF located near patient
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18
Q

Mapleson C is identical to Mapleson B except for what specific difference?

A
  • Omission of the corrugated tubing
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19
Q

Mapleson C is almost as efficient as ____ .
What is it based on?

A

A
based on expiratoy pause (longer pause = less efficient)
bc losing to atmosphere

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20
Q

How much FGF is needed for the Mapleson C circuit to prevent rebreathing?

A
  • FGF 2x minute volume to maintain efficiency
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21
Q

When are Mapleson’s C circuits usually used?

A
  • EmergenCy resuscitation
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22
Q

Where are the APL Valve and Fresh gas inlet located in the Mapleson D Circuit?

A
  • APL valve= near reservoir bag
  • FGF inlet = near patient
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23
Q

Which circuits are known to have “T-modifications” or are known as the “T-group”?
What makes up 3 way T-Piece?

A
  • Mapleson D
  • Mapleson E
  • Mapleson F
  • pt connection ,, fresh gas inlet ,, corrugated tubing
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24
Q

Which circuit is the MOST efficient for controlled ventilation?

A
  • Mapleson D
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25
Q

What kind of valve can be added to Mapleson D circuits?

A
  • PEEP Valve
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26
Q

FGF rate should be _______ times minute ventilation in Mapleson D circuits.

A
  • 2 to 2.5 times
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27
Q

What circuit is a modification of Mapleson D?
What is modified?

A
  • Bain Circuit
  • Fresh gas inlet through a narrow inner tube (coaxial)
  • Disconnection / kinking = problem if don’t realize it
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28
Q

What is another name for Mapleson E?

A
  • AryE’s T-piece
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29
Q

What is missing in the Mapleson E circuit?

A
  • No reservoir bag
  • No APL valve
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30
Q

Where does FGF enter the Mapleson E circuit?

A
  • Near the patient
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31
Q

What forms the reservoir if there is no Reservoir Bag on the Mapleson E circuit?

A
  • Corrugated Tubing
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32
Q

What 3 patients is the Mapleson E circuit designated for?

A
  • Spontaneous breathing patients to deliver O2
  • Pediatrics - bc decreased resistance d/t no APL
  • transport from OR
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33
Q

How would you increase the pressure of the Mapleson E circuit without an APL valve?

A
  • Occluding / pinching end of corrugated tubing
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34
Q

Mapleson F is a modified mapleson __.
What is the modification for the Mapleson F circuit called + what is it adding?

A
  • E
  • Jackson Reese Modification
  • Resorvoir bag added

Guys named Jackson + Reese think they’re Funny

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35
Q

What is missing in the Mapleson F circuit?

A
  • No APL Valve
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36
Q

Where is the FGF inlet on the Mapleson F circuit?

Where is the Reservoir Bag on the Mapleson F Circuit?

Is there anything special about the Reservoir Bag on the Mapleson F Circuit.

A
  • FGF inlet = near patient
  • Reservoir Bag = operator side
  • Reservoir Bag is open (hole)
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37
Q

How can pressure be generated in the Mapleson F Circuit?

A
  • reservoir bag hole occluded by operator’s hand to control bag distension + pressure
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38
Q

What does the reservoir bag on the Mapleson F circuit allow?

A
  • Allow for easy tactile and visual monitoring of the patient’s respiratory effort.
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39
Q

What is the FGF rate for the Mapleson F circuit?

A
  • 2-2.5 x minute ventilation
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40
Q

Improved rebreathing efficiency is due to what factor?

A
  • Location of APL valve relative to FGF

FGF located near patients will experience less rebreathing.

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41
Q

Which Mapleson Circuits will experience significant amounts of fresh gas vented through APL at end-expiration?

A
  • Mapleson B
  • Mapleson C
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42
Q

Which systems have FGF drives that drive exhaled alveolar gas away from pt?

A
  • Mapleson D
  • Mapleson E
  • Mapleson F
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43
Q

Rank the groupings of the Mapleson Circuit in efficiency for spontaneous ventilation.

A

Mapleson A > DFE > CB

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44
Q

Rank the groupings of the Mapleson Circuit in efficiency for controlled ventilation.

A

Mapleson DFE > BC > A

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45
Q

What are the 5 advantages of the Mapleson Circuit?

A
  • Simple, inexpensive, and lightweight
  • Changes in FGF composition result in rapid changes in the circuit
    * Low resistance to gas flow
  • **No toxic products **d/t lack of CO2 absorbent
    * No degradation w/ VAs
46
Q

What are the 4 disadvantages of the Mapleson Circuit?

A
  • Require high FGF (can be wasteful + have full O2 tank)
  • Conservation of heat + humidity = less efficient
  • Scavenging challenging (Except Mapleson D)
  • Not suitable for patients with **MH **(May not be possible to increase FGF to remove excess CO2)
47
Q

Circle System: Spontaneous Inspiration
(Allows for circular and unidirectional flow)
Ventilator ???

A

Ventilator NOT ON !! Bc spontaneous

48
Q

Circle System: Spontaneous Expiration

A
49
Q

During what respiratory cycle phase will the CO2 absorber experience the highest potential of drying out?

A
  • End of expiratory cycle d/t the fresh gas flow traveling retrograde because the inspiratory valve is closed.
50
Q

For the Circle System, the extent of rebreathing and conservation of exhaled gases depends on _______.

A
  • FGF
  • Higher FGF = less rebreathing + greater waste gas
51
Q

3 Rules to prevent rebreathing:

A
  • Unidirectional valve = must be located between pt + reservoir bag on both the inspiratory + expiratory limbs
  • fresh gas inflow= CANNOT enter circuit between expiratory valve and pt
  • APL valve= CANNOT be located between the pt and the inspiratory valve (You will lose FGF)
52
Q

What kind of circle systems are seen with contemporary/modern systems?

Will there be rebreathing that occurs?

Wast flow vented through?

A
  • Semi-closed circle system
  • Partial rebreathing occurs
  • some waste flow is vented through APL or waste gas valve of the ventilator
53
Q

What is an example of a semi-closed circle system?

A
  • Low-flow anesthesia (what we do)
  • FGF < Vm
54
Q

What percentage of expired gas is rebreathed after CO2 removal during low-flow anesthesia?

A
  • 50%
55
Q

What kind of circle systems are considered non-rebreathing? Why?

A
  • Semi-open Circle System
  • Higher FGF = minimal rebreathing + more venting of waste gas
56
Q

What is an example of a semi-open circle system?

A
  • Post-Op + ICU vents
  • Scuba gear
  • *Mapleson Circuits**
57
Q

In what Circle System will the oxygen inflow rate exactly match the metabolic demand? Rebreathing is ________ .
What is added to circuit in liquid form ?

A
  • Closed Circle System
  • Rebreathing is complete; no waste gas vented
  • Volatiles = circuit in liquid form or through vaporizer
58
Q

Example of a closed circle system.

A
  • Low- and minimal-flow anesthesia
  • Impractical for use – rarely done
  • OBSOLETE
59
Q

3 Advantages of Low-Flow Anesthesia

A
  • Decreased use of volatiles
  • Improved temperature + humidity control
  • Reduced environmental pollution
60
Q

3 Disadvantages of Low-Flow Anesthesia

A
  • Difficulty rapidly adjusting the anesthetic depth (why we overpressurize)
  • Possibility of accumulating unwanted exhaled gases ( ex: CO, acetone, methane)
  • VA degradation by-products (ex: CO, compound A)
61
Q

5 Advantages of Circle System

A
  • Low FGF can be used
  • Elimination of CO2
  • Relatively stable inspired gas concentration
  • Conservation of moisture/heat/gases
  • Prevention of OR pollution
62
Q

4 Disadvantages of Circle System

A
  • Complex design
  • CO or compound A
  • May compromise Vt during controlled ventilation **
  • **ASA Closed Claims Project **(Misconnections/ disconnections) **
63
Q

6 Components of the Self-Inflating Manual Resuscitators (AMBU bags)

A
  • Self-expanding Bag
  • T-shaped non-rebreathing Valve
  • Bag Inlet Valve
  • Pop-off valve
  • Excess oxygen venting valve
  • Oxygen reservoir
64
Q

Use of Self-Inflating Manual Resuscitators

A
  • Hand ventilation in absence of oxygen / air source
  • Pt transport
  • CPR
  • Emergency back-up
  • ALWAYS have set up with machine
65
Q

4 Hazards of Self-Inflating Manual Resuscitators

A
  • Barotrauma
  • gastric insufflation
  • Significant variation of :: Vt, PIP, + PEEP
  • Nonrebreathing valves = generate resistance
66
Q

What is the purpose of bacteria filters? What 3 diseases

A
  • prevent contamination / infection by airborne diseases
  • TB, COVID, PUI
  • preventing contamination of anesthesia machine from airborne diseases
67
Q

Where are bacteria filters placed on the breathing circuit?

A

***** Placed on the expiratory limb

68
Q

Bacteria Filters - Small-pore
Due to the small-pore compact matrix, there will be ________ airflow resistance.

The small-pore compact matrix is also _______ to create a larger ________.

A
  • high
    *pleated – surface area
69
Q

Bacterial Filters

Larger Pore size = _____ resistance + ______ surface areas (compared to small pore)

A

Less ,, smaller

70
Q

Bacterial filters = permanent electrical _____

A

polarity

71
Q

Hydrophobic Bacterial Filters will prevent _____.

A
  • water penetration
72
Q

When the Hydrophobic Bacterial Filters become wet, it will increase ________ and decrease __________.

A
  • Increase resistance
  • Decrease efficiency
73
Q

Where are combination filters (filter + HME) placed in the breathing circuit?

A
  • Placed at the Y-piece

This will cause a barrier to the inspiratory and expiratory limb, increasing resistance.

74
Q

2 Complication of Bacterial Filters.

A

*. Obstruction (Sputum, edema fluid, nebulized aerosols, or malpositioning)
* Leakage of the housing of the gas line filter (best to monitor ETCO2 before the filter)

75
Q

When is an inspiratory limb filter recommended? Airway filter?

A
  • When machine may be been **contaminated by previous **patient
  • Airway = **COVID + PUI **pts
  • Expiratory limb = preferred for ALL

Expiratory limb filter recommended for ALL patients.

76
Q

Humidity

A
  • Amount of water vapor in a gas
77
Q

Absolute humidity

A

***** Mass of water vapor present in gas in mg H2O/L of gas
* 34-38 mg of H2O/ L gas in mid trachea

78
Q

Relative Humidity

A
  • Percent saturation; the amount of water vapor at a particular temp
79
Q

Water Vapor Pressure

A

The pressure exerted by water vapor in a gas mixture.

80
Q

Maximal contact of inspired gas occurs with the large mucosal surface area in the _______.

A
  • Nasal Cavity
81
Q

Most of heating and humidification of inspired gas has occurred by _______.

At ___ degrees with absolute humidity of __________ + a relative humidity of _______%

A
  • Mid-trachea
  • 34 degrees – 34-38 mg/L – 95-100%
82
Q

Where is the Isothermic Saturation Boundry ? What 3 things does it depend on?

A
  • at carina
  • vol gas inhaled ,, humidity ,, temp
82
Q
  • As gas travels _____ it is heated to body temperature.
  • At 37 degrees = Absolute humidity of ___ mg/L + relative humidity of ____%
A
  • distally
  • 44 mg/L + 100%
83
Q

What are the effects of cold ambient temperatures regarding humidification in the airway?

A
  • Little capacity to hold water vapor
  • Low absolute humidity
  • Upper airway **transfers large amounts **of heat and moisture
84
Q

Cool inspired gases may trigger _________.

A
  • Bronchospasm
85
Q

8 Effects of underhumidifaction.

A
  • Damage to the respiratory tract
  • Secretions thicken
  • Ciliary function decreases
  • Surfactant activity is impaired
  • Mucosa susceptible to injury
  • Body heat loss (longer cases)
  • Tracheal tube obstruction (thicken secretions)
  • Increases resistance and work of breathing from thickened secretions
86
Q

Effects of overhumidifaction.

A
  • Condensation of water in the airway
  • Reduced mucosal viscosity and risk of **water intoxication **
  • Inefficient mucociliary transport
  • Airway resistance, risk of **pulmonary infection, surfactant dilution, atelectasis, **and V/Q mismatch
  • Obstruction to sensors - ETCO2 sample line obstruction
87
Q

Functions of humidification devices.

A

reproduce normal physiologic conditions in lower respiratory tract

88
Q

Types of humidification devices

A
  • Heat and moisture exchanger (HME- Passive and can be modified to have a filter
  • Heated humidifiers- Active
89
Q

Functions of Heat and Moisture Exchanger (HME)

A
  • Conserves some exhaled heat and water + returns to pt
  • Bacterial/viral filtration and prevention of inhalation of small particles (HMEF)
90
Q

Where is the placement of an HME?

A
  • Placed close to the pt, between Y piece and proximal end of ETT or LMA
91
Q

What happens to the ETCO2 reading if the sensor is placed AFTER the HME?

A
  • Low ETCO2 reading
92
Q

What does the HME do to the resistance and dead space in the circuit?

A
  • ↑ resistance
  • ↑ dead space
93
Q

What happens to the efficiency of the HME with a large tidal volume?

A
  • ↓ Efficiency
  • Hydrophobic models
94
Q

What is a Hygroscopic HME?

A
  • Paper or other fiber barrier coated with moisture-retaining chemicals
  • May have some electrostatic properties
  • Absorb water in exhalation and release it in inspiration
95
Q

What is Hygroscopic HME most efficient at?

A
  • Most efficient at retaining heat and moisture
96
Q

What is the drawback of Hygroscopic HME?

A
  • Prone to becoming saturated
  • Increased inspiratory/expiratory resistance
  • Reduced heat and moisture retention efficiency
97
Q

What is a Hydrophobic HME?

What is a Hydrophobic HME efficient at?

A
  • Pleated hydrophobic membrane with small pores
  • More efficient filters of pathogens
98
Q

Devices used to increase the humidity in O2 supplied to pts

A
  • Humidifiers
99
Q

Who will benefit from humidifiers? 3

A
  • Neonates
  • Pts with respiratory secretions
  • Hypothermic pts
100
Q

What are the different ways a humidifier can pass a stream of gas?

A
  • Bubble or cascade
  • Pass-over
  • Counter-flow
  • Inline
101
Q

Where are the humidifiers placed in the breathing circuit? Heated humidifer placed?

A
  • Placed in the inspiratory limb downstream of unidirectional valve
  • Heated humidifiers = NOT in expiratory limb
102
Q

Describe the Bubble/Cascade humidifier.

A
  • Bubble humidifiers are a type of active humidifier that work by passing the fresh gas flow down a tube through a water reservoir causing the gas to “bubble.” Water vapor is absorbed as the bubbles pass through the reservoir
103
Q

Describe the Passover humidifier.

What are the two varients of this humidifier?

A
  • Passover humidifiers work by passing gas over a heated water reservoir.
  • There are two variants: one that utilizes a wick and one that utilizes a hydrophobic membrane.
104
Q

Describe the Counter-flow humidifier.

A
  • Water is heated outside the vaporizer in counter-flow humidifiers.
  • After the water is heated, it is pumped to the top of the humidifier, entering small diameter pores and running down a large surface area.
  • Gas, flowing in the opposite direction, is warmed and humidified to body temperature.
105
Q

Describe the inline vaporizer humidifier.

A
  • Inline vaporizer humidifiers utilize a plastic capsule that injects water vapor and heat directly into the inspiratory limb of the ventilator circuit just before the patient’s y-piece.
106
Q

Most unheated humidifiers are disposable that use the bubble-through humidifier that increases the humidity in oxygen supplied to patients via a face mask or nasal cannula. They cannot deliver more than about ______ mg H2O/L.

A
  • 9 mg H2O/L
107
Q

Condensation has what effect on tidal volume?

A
  • Decrease delivered Vt
108
Q

Consideration for water traps.

A
  • Change frequently to decrease the risk of contamination and infection
109
Q

Advantages of Humidifiers

A
  • Can deliver saturated gas at body temp or higher
  • More effective than HME in longer cases in preventing hypothermia
110
Q

Disadvantages of Humidifiers

A
  • Bulky
  • Potential electrical malfunction and/or thermal injury
  • Contamination, and cleaning issues
  • Higher cost than HME
    * Water aspiration risk

Principles I* (20 decks)

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