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Exam I: One Lung Ventilation Flashcards

1
Q

OLV Double Lumen Tube

A
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2
Q

Intentional collapse of a long on the operative side of a patient which facilitate most thoracic procedures

A

One lung ventilation

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3
Q

what are two reasons one lung ventilation is difficult from an anesthesia perspective

A
  1. Difficult to place long isolation equipment
  2. Tends to dislodge when positioning patient
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4
Q

Surgical Lung

A
  • operative lung
  • non-dependent lung
  • non-ventilated lung
  • superiorly located (for surgeon to operate)
  • up lung
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5
Q

non-surgical lung

A
  • non-operative lung
  • dependent lung
  • ventilated lung
  • inferiorly located
  • down lung
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6
Q

PEEP is applied to the ____ lung

A

dependent

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7
Q

CPAP is applied to the ____ lung

A

non-dependent

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8
Q

what is the physiologic goal during OLV?

A
  • promote blood flow to the nonsurgical dependent lung
  • Contribute to improved VQ matching
  • Reduce PVR of dependent long (pulmonary vascular resistance)
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9
Q

Things that increase PVR of the dependent lung

A

Excessive PEEP
Airway pressures
Hypoxia
Hypercapnia
Hypovolemia

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10
Q

Increased PVR of dependent long leads to a/an ____ shunt fraction.

A

increased

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11
Q

Lung that is collapsed to facilitate the surgery

A

Nondependent lung or up lung

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12
Q

what are absolute indications for one lung ventilation

A
  • Isolation of one lung from another (prevent spillage or contamination)
  • control of distribution of ventilation (bronchopleural fistula, surgical opening of major conducting airway)
  • unilateral bronco pulmonary lavage (pulmonary alveloar proteinosis)
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13
Q

Relative indications for one lung ventilation

A
  1. Surgical exposure – high-priority
  2. Surgical exposure – lower priority
  3. Other: Post removal of totally occluding chronic unilateral pulmonary emboli
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14
Q

Examples of high priority surgical exposure indications for one lung ventilation

A
  1. Thoracic aortic aneurysms
  2. Pneumonectomy
  3. Upper lobectomy
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15
Q

Examples of lower priority surgical exposure indications for one lung ventilation

A
  1. Middle lobe lobectomy
  2. Esophageal resection
  3. Thoracoscopy
  4. thoracic spine procedures
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16
Q

what are the three methods of lung separation

A
  1. Single lumen endobronchial tubes
  2. Double lumen endobronchial tubes
  3. Bronchial Blockers
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17
Q

examples of double-lumen endobronchial tubes?

A
  • Gordon-Green (R)
  • Robert-Shaw (R or L)
  • Carlens (L)
  • White (R)
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18
Q

what sizes are used for double lumen tubes?

A

adult: 35Fr-41Fr

Peds: 28Fr and 32 Fr

19
Q

Examples of Bronchial blockers

A
  • single lumen tracheal tube with a bronchial blocker (Univent)
  • Stand alone endobronchial blockers (Arndt, Cohen, Uniblocker, EZ-Blocker)
  • Arterial embolectomy catheter (Fogarty)
20
Q

right sided DLT: Fiberoptic Bronchoscopy

21
Q

advantages to double lumen tubes

A
  • relatively easy to place
  • allow conversion back and forth from OLV to two-lung ventilation
  • allow suctioning of both lungs individually
  • allow CPAP to be applied to ND lung
  • allow PEEP to be applied to D lung
  • ability to ventilate around scope in the tube
22
Q

Disadvantages to DL tube

A
  • cannot take pt to PACU or the Unit
  • must be changed out for a regular ETT if post-op ventilation
  • ## correct positioning is dependent on appropriate size for height of pt - length of trachea
23
Q

DLT placement

A
  • prepare & check tube (cuffs)
  • lubricate tube
  • insert tube with distal concave curvature facing anteriorly
  • remove stylet once through the vocal cords
  • rotate tube 90° (in direction of desired lung)
  • advancement of tube ceases when resistance is encountered (29cm +/- 2cm)
  • if carinal hook is present, must watch hook go through cords to avoid trauma to them
24
Q

EBB (Endobronchial Blocker):

wire loop to snare the FB

A

Arndt Blocker

25
EBB: deflecting tip
Cohen Blocker
26
EBB: Prefixed bend
Uniblocker
27
EBB: Double-lumen bifurcated tip
EZ-Blocker
28
which two EBB are available in peds (5.0F) size?
Arndt & Uniblocker
29
EBB Disadvantage: EBB not visualized during insertion
Arndt
30
EBB disadvantage: Expensive
Cohen
31
EBB Disadvantage: no steering mechanism; prefixed bend
Uniblocker
32
EBB disadvantage: Each lumen is too small; impossible to suction
EZ-Blocker
33
____ involves the deliberate collapse of a lung; perfusion still takes place but not ventilated, which increases shunt
OLV
34
factors limiting blood flow to non-ventilated lung
- hypoxic pulmonary vasoconstriction (HPV) - Surgeon (compression, clamping)
35
____ is a powerful stimulus for pulmonary vascular vasconstriction
hypoxia
36
during HPV, what occurs with regard to blood flow
- body diverts blood flow away from areas of no ventilation to areas of ventilation - vasoconstriction that decreases blood flow frmo alveoli that are not ventilated to alveoli that are ventilated
37
physiologic factors that inhibit HPV in non-ventilated lung
- pulmonary HTN - hypocapnia - alkalosis - increased CO - increased mixed venous PO2 - hypothermia
38
anesthetic drugs that inhibit HPV in non-ventilated lund
- direct acting vasodilators & phosphodiesterase Inhibitors - VA at higher concentrations - Propofol and Fentanyl have no effect on HPV
39
Without HPV, what would occur ?
- increased shunt - decreases PaO2
40
Ventilatory factors applied to the OLV that worsen HPV (to ventilated lung)
- high mean airway pressures - hyperventilation - high peak inspiratory pressures - a low FiO2 (produces HPV in the ventilated lung) - intrinsic PEEP or auto PEEP
41
Goal of initial settings for OLV
- maintain adequate alveolar ventilation - minimize the amount of shunt through the non-ventilated lung
42
Initial OLV ventilator settings
- FiO2: 0.6-0.8 - RR: 15-20 - PCV: (adjust to achieve protective ventilation: Vt 6mL/kg IBW) - use high FiO2 (preferably not 100%), decrease as much as possible to increase HPV in non-ventilated lung - PEEP: 5-10 cmH2O
43
if hypoxia occurs, what can be delivered to the down lung (non-ventilated lung)?
CPAP (5-10 cmH2O)

Class (4 decks)

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