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6902- Cullen > OLV > Flashcards

OLV Flashcards

1
Q

Ventilation is sum of all inhaled or exhaled gasses in one min?

A

exhaled

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2
Q

Type of dead space that is nonresp airways?

A

anatomic dead space

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3
Q

Type of dead space that is alveoli that are not perfused?

A

alveolar dead space

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4
Q

What is the sum of anatomic and alveolar dead space?

A

physiologic

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5
Q

What is the typical dead space in most adults in upright patient? And it is mostly what type of dead space?

A

150 mL; 2mL/kg; anatomic

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6
Q

How can you grossly estimate anatomic dead space?

A

weight of individual in pounds is roughly equivalent to dead space in mL

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7
Q

Right and left lung receive what % each of ventilation?

A

right lung- 53%; left lung- 47%

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8
Q

Are the upper or lower areas better ventilated?

A

lower

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9
Q

Why are the lower areas of lungs better ventilated?

A

gravitationally induced gradient in intrapleural pressure and therefore transpul pressure

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10
Q

What does a higher transpulmonary pressure in the upper part of the lungs mean for inspiration?

A

the alveoli in the upper lungs are near maximally inflated and relatively non compliant so they undergo little expansion during inspiration

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11
Q

What happens to the smaller alveoli in dependent areas during inspiration?

A

they have a lower transpulmonary pressure, are more compliant, and undergo greater expansion

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12
Q

Laminar flow resistance is proportional to? And which law is this?

A

viscosity x length of conduit divided by radius to 4th power; Poiseulle’s

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13
Q

Flow is proportional to?

A

change in pressure x radius 4th power divided by viscosity times length

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14
Q

Halving the radius does what to flow?

A

flow is 1/16 what it was

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15
Q

Is pulmonary blood flow uniform?

A

no

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16
Q

One example where zone 1 would be present?

A

pulmonary hypotension

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17
Q

What are the characteristics of the pressures in Zone 1?

A

pulmonary alveolar > pulmonary artery > pulmonary vein

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18
Q

How are the capillaries in zone 1?

A

capillaries are depressed, blood flow is impeded

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19
Q

Why is vascular resistance increased in zone 1?

A

apical alveoli are inflated

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20
Q

What is the net result as far as ventilation and perfusion in zone 1?

A

ventilation without perfusion

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21
Q

What do the capillaries do in zone 2?

A

flutter open and closed in inspiration and expiration

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22
Q

What are the pressures in zone 2?

A

pulmonary artery > alveolar > venous

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23
Q

How is blood flow determined in zone 2?

A

pressure gradient between arterial and alveolar pressures

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24
Q

How are the pressures related in zone 3?

A

pulmonary artery > pulmonary vein > alveolar pressure

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25
Q

How is flow determined in zone 3?

A

arterial venous pressure differences

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26
Q

Where should the tip of the swan be?

A

zone 3

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27
Q

2 examples where zone 4 is present?

A

ARDS, pulmonary edema

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28
Q

What are the pressure relationships in zone 4?

A

interstitial pressure > venous and alveolar pressure

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29
Q

How do you determine blood flow in zone 4?

A

pulmonary artery minus pulmonary interstitial fluid gradient

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30
Q

Where is pleural pressure least negative?

A

base of lung

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31
Q

3 other characteristics of base of lung besides pleural pressure being least negative?

A

alveoli most compressed, most compliant, smallest volume

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32
Q

Where is pleural pressure most negative in upright person?

A

apex

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33
Q

3 other characteristics of apex of lung other than pleural pressure being the most negative?

A

alveoli not compressed, alveoli have greatest volume, alveoli least compliant

34
Q

Ventilation preferentially goes to the base of the lung why?

A

pleural pressure least - in base and alveoli most compliant

35
Q

Pleural pressure increases by what cm H2O per cm of lung dependency (down the lung)?

A

0.25

36
Q

At a normal tidal volume range, which part of the lung receives the majority of ventilation?

A

dependent/base bc apex alveoli already overdistended they’re poorly compliant

37
Q

The dependent/base of the lung is (ventilation and perfusion wise)?

A

ventilated and preferentially perfused

38
Q

In an awake lateral position, the apex and base are equal in which part of the lung?

A

dependent

39
Q

Distribution of ventilation is changed in an anesthetized paralyzed patient how?

A

changed from the dependent lung to the nondependent lung

40
Q

In an anesthetized paralyzed patient how are ventilation and perfusion distributed in the lateral position?

A

dependent lung is poorly ventilated and well perfused, shunting; nondepedent lung is well ventilated and not well perfused, deadspace

41
Q

Why are FRC and compliance of dependent lung in an anesthetized pt in lateral position decreased?

A

abdominal contents pushing on dependent lung, weight of the mediastinum compresses that lung, axillary rolls compresses that lung

42
Q

Decreased FRC and compliance in the dependent lung favor ventilation in?

A

non dependent lung

43
Q

Once the chest wall is opened, compliance greatly increases where?

A

non dependent lung

44
Q

What is the sequence of cephalaud displacement of lungs?

A

supine, induction, paralysis, surgical position, displacement by retractors and packs

45
Q

In OLV, which lung is ventilated and which collapsed? What type of mismatch do you get?

A

dependent ventilated, nondependent collapsed; shunt flow

46
Q

How do the lungs function to decrease shunt flow in OLV?

A

arteriolar smooth muscle contract in areas of lung which have decreased PAO2. this directs blood flow away from the hypoxic regions

47
Q

Normal perfusion w 2 lung ventilation, dependent lung gets what % of blood flow and nondependent lung which %?

A

dependent gets 60%, nondependent 40%

48
Q

OLV with HPV, dependent and nondependent lungs get what % of blood flow?

A

nondep gets 20%, dep gets 80%

49
Q

HPV is more effective when what % of the lungs are hypoxic?

A

30-70

50
Q

What type of shunt happens w OLV and HPV?

A

right to left

51
Q

Conditions that worsen right to left shunt w OLV and HPV?

A

very high or low PAPs, hypocapnia, high or low mixed venous PO2, vasodilators, inotropes, beta agonists, Ca channel blockers, pulmonary infection

52
Q

Conditions that reduce HPV indirectly?

A

vasopressors, high airway pressures (PEEP, high inspiratory pressure), low FiO2

53
Q

Is CO2 affected by OLV if MV is not changed?

A

usually not

54
Q

Surgeries that may need OLV?

A

pneumonectomy, lobe resection, segmental resection, thoracic aneurysm repair. esophageal surgeries, thoracoscopy, single lung transplant, anterior approach to thoracic spine, bronchioalveolar lavage,

55
Q

Pt related indications for OLV?

A

confine infection or bleeding to one lung, separate ventilation to one lung (bronchopleural fistula, tracheobronchial disruption, large lung cyst or bulla), severe hypoxemia d/t unilateral disease

56
Q

3 techniques for providing OLV?

A

double lumen bronchial tube, single lumen tracheal tube in conjunction w bronchial blocker, single lumen bronchial tube

57
Q

For a DLT, opening the port on appropriate side allows which lung to collapse?

A

ipsilateral

58
Q

Most commonly used DLT?

A

Robertshaw type

59
Q

DLT size range for men? for women?

A

39-41; 35-37

60
Q

DLT size is based on pt’s?

A

height

61
Q

DLT Carlens, which bronchus is intubated and is there a carinal hook?

A

left, yes

62
Q

DLT White, which bronchus is intubated and is there a carinal hook?

A

right yes

63
Q

DLT Robertshaw, which bronchus is intubated and is there a carinal hook?

A

right or left; no

64
Q

Which sided DLT has big murphy’s eye? and bc of that which sided DLT is usually used?

A

right; left

65
Q

One negative ab the carinal hook?

A

may irritate the carina and cause cough

66
Q

Where is the Murphy Eye on the White tube?

A

right past the tracheal cuff and above bronchial cuff

67
Q

How do you pass a DLT?

A

distal curve concave up/anteriorly and rotated 90 degrees towards side of bronchus to be intubated after tip/bronchial balloon enters larynx rotate it 90 degrees then take out stylet and advance until resistance felt

68
Q

Tracheal cuff requires how many mL for inflation?

A

5-10

69
Q

Unilateral breath sounds indicate that?

A

tube too far down (tracheal opening is bronchial)

70
Q

How much air do you put in bronchial cuff?

A

1-2 mL

71
Q

Which cuff do you inflate first on a DLT?

A

tracheal

72
Q

Malposition of a DLT is usually indicated by what 2 things?

A

low exhaled TV and poor lung compliance

73
Q

If unilateral breath sounds are heard after inflating the tracheal cuff on a DLT, where is the tube?

A

tube is too far down; tracheal opening is bronchial

74
Q

When checking for placement of a DLT, after you inflate the bronchial tube, what step is next?

A

clamp the tracheal lumen and check for unilateral breath sounds

75
Q

Which lumen do you place the fiberoptic bronchoscope down to check for left DLT placement?

A

right

76
Q

When looking through a fiberoptic bronchoscope, where should the endobronchial cuff be?

A

just below tracheal carina

77
Q

Review slide 45

A

yes review it

78
Q

What is one complication from overinflation of the bronchial cuff?

A

tracheobronchial rupture. this is associated w high morbidity and mortality

79
Q

What’s a disadvantage of a bronchial blocker, besides that it is hard to place?

A

blocked lung collapses slowly and sometimes incompletely bc of the small size of the channel w/in the blocker

80
Q

What’s a Gordon Green tube?

A

right sided single lumen tube used for left thoracotomies

81
Q

What are 2 advantages and disadvantages ab the Gordon Green tube?

A

had bronchial and tracheal cuff, carinal hook, hazard of carinal hook, inability to suction the left lung

82
Q

How can you prevent brachial plexus injury w positioning in lateral position?

A

rolled towel or small pillow under axillary

6902- Cullen (10 decks)

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