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CV Perf Tech III > Pulmonary Response to CPB- Exam 1 > Flashcards

Pulmonary Response to CPB- Exam 1 Flashcards

1
Q

Atelectasis

A

A complete or partial collapse of a lung or a lobe of the lung; develops when the alveoli become deflated and don’t inflate properly

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2
Q

What is the most common pulmonary complication?

A

Atelectasis

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3
Q

How common is atelectasis?

A

70%

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4
Q

What happens when lungs with atelectasis are re-expanded and ventilated?

A

Variable degree remains (microscopic/lobar)

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5
Q

Atelectasis results in impaired ___________.

A

Oxygenation

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6
Q

Atelectasis results in decreased ______________(3). What percent after anesthesia? What percent after CPB?

A

Functional Residual Capacity; decreased by 20% after general anesthesia, by 40-50% after CPB

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7
Q

Atelectasis results in decreased _______________(2).

A

Lung compliance

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8
Q

Atelectasis results in increased _________ (2).

A

Veno-arterial admixure

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9
Q

What happens to the alveolar-arterial oxygen gradient in atelectasis?

A

P(A-a)O2 increases

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10
Q

Factors Contributing to Atelectasis: PREOPERATIVE

A

Smoking, chronic bronchitis
Obesity
Cardiogenic pulmonary edema

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11
Q

Factors Contributing to Atelectasis: INTRAOPERATIVE

A

Anesthesia: reduced surfactant function
passive ventilation
Monotonous ventilator pattern

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12
Q

Factors Contributing to Alelectasis: BYPASS

A

Surfactant inhibition
Plasma, lung distention, lung ischemia
Increased extravascular lung water ( complement activation)
heart rests on immobile left lower lobe
Open pleural cavity- accumulation of blood and fluid

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13
Q

What can we do to prevent atelectasis?

A

Decreased complement activation
Reduced chances of edema
Anesthesia has more control (i.e. how lungs are deflated and re-inflated)

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14
Q

What can anesthesia do to prevent atelectasis?

A

PEEP
CPAP
OLC (open lung concept)

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15
Q

Open Lung Concept

A

a method of ventilation intended to maintain end- expiratory lung volume by increased airway pressure.

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16
Q

When was “Pump Lung” a big problem?

A

1950’s

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17
Q

What is “Pump Lung”

A 
Acute respiratory failure
Lungs diffusely congested
Intra-alveolar and interstitial edema
Hemorrhagic atelectasis
Vessel lumina full of neutrophils
Diffuse swelling of endothelial cells
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18
Q

What might cause acute lung injury?

A 
Embolic load
membrane damage from immune response
decreased pulmonary blood flow
hemodilution
elevated pulmonary artery pressure
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19
Q

What can emboli lead to?

A

Areas of ventilation/perfusion mismatching

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20
Q

What can cause the ventilation/perfusion mismatching from emboli?

A 
Aggregated proteins
Disintegrated platelets
Damaged neutrophils
Fibrin
Fat Globules
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21
Q

What can greatly reduce degenerative lesions in lungs?

A

Introduction of arterial and cardiotomy filters

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22
Q

Better the ________-more normal the lungs.

A

Filtration

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23
Q

Acute Lung Failure: Membrane Damage

A

Complement Activation
Vasoactive compounds from PMNs
Oxygen free radicals
Ischemia reperfusion injury

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24
Q

Where is complement activation found?

A

Found wherever blood meets foreign surface

Ex. Hemodialysis, leukophoresis

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25
What functions for fighting invading organisms does complement activation have?
Leukocyte activation Cytolysis Opsonization
26
Opsonization
makes bacterial cells vulnerable to phagocytosis by attaching various items
27
Lungs are ______ from pulmonary circulation during bypass.
Isolated
28
(T/F) Lung tissue does not have any metabolic activity on bypass.
False, lung tissue still has metabolic activity
29
What is the lung metabolic activity on bypass at 36 C?
11/ ml/min
30
What is the lung metabolic activity on bypass at 28 C?
5 to 6 ml/min
31
Is bronchial circulation functional on bypass?
Yes
32
Complement results in ____________(2).
Localized vasoconstriction
33
What is our concern with hemodilution?
Decrease in COP | Movement of fluid into the intracellular space
34
Studies indicate the accumulation of pulmonary extravascular water ________ (is/is not) affected by the type of priming solution.
Is not
35
Does hemodilution harm the lungs?
No
36
Hemodilution prevents impairment of ________________.
Surfactant
37
What is a potential cause of pulmonary edema?
Elevated PA Pressure; due to inadequate venting, increased bronchial blood flow
38
Elevated PA Pressure can cause
Pulmonary edema | Complement edema
39
What triggers acute fulminant bronchospasm on bypass?
Activation C5a
40
Fulminant bronchospasm
severe, sudden bronchospasm
41
What triggers acute bronchospasm on bypass?
Cold urticaria syndrome Preexisting bronchospastic disease instrumentation secretions cold anesthetic gas in patients with hyperactive airways allergic reactions to antibiotics or protamine drugs that induce histamine release
42
What happens with cold urticaria syndrome?
Release histamine when exposed to cold
43
How do you manage bronchospasm?
Stay on bypass or reinitiate bypass | Rest up to anesthesia
44
What can anesthesia manage bronchospasm?
Beta selective agonists directly into endotrachial tube (albuterol, metaproterenol) Small iV bolusis of epi followed by continuous low dose infusion IV lidocaine given to decrease airway hyperactivity volatile anesthetic agnets can be given through pump
45
Volatile anesthetics
potent bronchodilators
46
What does halothane do?
(Volatile anesthetic) | sensitizes myocardium to catecholamines- risk of tachyarrythmias
47
Prevention and Tx of Acute Lung Injury
``` Blood filtration Coated circuits Membrane oxygenators hemodilution proper LV venting Steroids ```
48
What does Blood filtration do?
Leukocyte depletion | Removal of endothelin 1
49
What do steroids not affect?
C3a activation or leukocyte elastase release
50
Steroids may inhibit what?
Increase in leukotriene B4 and tissue plasminogen activator
51
What other problems can steroids cause?
Increased blood loss | low cardiac output syndrome
52
What may be more protective than corticosteroids?
Prostaglandins
53
What do prostaglandins do?
Inhibits intravascular pulmonary leukocyte aggregation, activation, and free radical production Hypotensive effect!!
54
What does aprotinin inhibit?
Serine proteases (plasmin & kallikrein)
55
Aprotinin prevents the activation of what
Kininogen and formation of bradykinin
56
What reduces blood usage by preventing platelet aggregation and inhibiting fibrinolysis?
Aprotinin
57
What does aprotinin attenuate?
Bradykinin-induced increases in vascular permeability
58
Aprotinin results in reduced ________(2) accumulation after bypass.
Lung neutrophil
59
Endogenous production of what is reduced post CPB
Nitric Oxide
60
What does inhaled nitric oxide do?
Provides potent vasodilation in the pulmonary vasculature
61
What is used to treat elevated pulmonary vascular resistance?
Inhaled Nitric oxide
62
What other effects does inhaled nitric oxide have?
Some anti-inflammatory properties - Decreases IL-8 - Attenuates neutrophil adhesion and migration - Attenuates apoptosis in lungs

CV Perf Tech III (16 decks)

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