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CI1 > Reduced Lung Volume > Flashcards

Reduced Lung Volume Flashcards

1
Q

How is alveolar ventilation measured?

A

Respiratory rate x (tidal volume - deadspace)

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2
Q

What is regional ventilation?

A

Ventilation in specific regions of the lung

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3
Q

What is minute ventilation?

A

Respiratory rate x tidal volume

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4
Q

What is functional residual capacity?

A

Resting volume of the lung at the end of tidal breaths

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5
Q

What is the difference between atelectasis and lung collapse?

A
  • Atelectasis is the collapse of alveoli

- Lung collapse is the collapse of whole regions of the lung

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6
Q

What is FRC a balance of?

A
  • Inward elastic recoil of the lungs

- Springing out of the ribcage

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7
Q

What is closing capacity?

A

Volume of gas in the lungs at the time when small airways in the dependent portions (lower portions) of the lungs close during maximal exhalation

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8
Q

Why is pleural pressure less negative at the bottom of the lungs?

A

Because gravity pulls down the weight of the lung, making the space bigger (i.e. less pressure)

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9
Q

How is closing capacity measured?

A

Single breath nitrogen test

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10
Q

What factors does closing capacity increase with?

A

Age, COPD, smoking (loss of elastic recoil)

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11
Q

What is the relationship between closing capacity and body position?

A
  • Higher when standing upright

- Lower when supine

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12
Q

What occurs when CC > FRC?

A

Dependent airway closure occurs during tidal breathing, i.e. much more likely to get lung collapse in those airways

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13
Q

What is the difference between CC and equal pressure point?

A
  • CC is a volume
  • EPP is where pleural pressure & pressure within alveoli are equal causing dynamic collapse (pressure-related, nothing to do with dependence/non-dependence)
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14
Q

What are the causes of reduced lung volume?

A
  • External compression of lung tissue
  • Reduced chest wall compliance
  • Reduced central drive
  • Decreased ability of respiratory muscles to generate force
  • Loss of alveolar volume
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15
Q

What can cause external compression of lung tissue?

A
  • Pleural space: Pleural effusion, empyema (pus), pneumothorax
  • Abdomen: ascites (fluid), pregnancy, obesity
  • Rib cage: Posture, flail segment, kyphoscoliosis
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16
Q

What causes reduced chest wall compliance?

A
  • Kyphoscoliosis
  • Obesity
  • Pregnancy
  • Age
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17
Q

What causes reduced central drive?

A
  • Altered patterns of breathing
  • Brainstem injury (medulla)
  • Often causes reduction in tidal volume
18
Q

What are some of the different patterns of reduced central drive?

A
  • Cheyne-Stokes (just before death, breathing all over the place)
  • Biot’s breathing
19
Q

What decreases the ability of respiratory muscles to generate force?

A
  • Neuromuscular disease (MND, stroke, spinal injury, phrenic nerve palsy)
  • Deconditioning or fatigue (mechanical ventilation, COPD, illness)
20
Q

What is required in order for the lungs to remain compliant?

A
  • Elasticity

- Surfactant

21
Q

What causes loss of alveolar volume?

A
  • Post-op atelectasis
  • Mucus plugging
  • Removal of lung tissue
22
Q

How is laparoscopic abdominal surgery different to open laparotomy?

A
  • Less pain
  • Less analgesic requirements
  • Improved mobility
  • Reduced hospital length of stay
  • Lower incidence of post-op pulmonary complication (PPC)
23
Q

What type of pain is laparoscopic surgery associated with?

A

Shoulder tip pain

  • cause uncertain
  • may be related to CO2 insufflation, irritation of diaphragm or peritoneum
  • often worse with deep breathing
24
Q

Why do physios not routinely assess patients following laparoscopic procedures?

A

They are low risk, shoulder tip pain is non-mechanical (i.e. can’t be fixed with physio)

25
Q

What are examples of upper abdominal surgery?

A
  • Splenectomy
  • Liver resection
  • Oesophagectomy (2 incisions, higher risk)
  • Head of pancreas (2 incisions, higher risk)
26
Q

What are examples of lower abdominal surgery?

A
  • Colectomy

- Nephrectomy

27
Q

What is an example of vascular abdominal surgery?

A
  • Abdominal aortic aneurysm (AAA) repair & grafting

- High risk of PPC due to smoking history

28
Q

What are some of the potential complications of surgery?

A
  • Respiratory complications
  • Wound infection
  • Bleeding/haemorrhage
  • Cardiovascular problems
  • DVT
  • Pulmonary embolus
  • Renal failure
  • Nausea/vomiting
  • Psychosis
  • Reduced gut mobility
  • Musculoskeletal problems
  • Exacerbation of pre-existing conditions
29
Q

What surgeries are most commonly associated with PPCs?

A

Upper abdominal surgery & cardiothoracic surgery

30
Q

What are the criteria for PPCs (requires 4 or more to be classified as PPC)?

A
  1. CXR report of collapse/consolidation
  2. Maximal oral temperature >38 deg for >1 consecutive days post op
  3. SpO2 <90% on >1 consecutive day post op
  4. Yellow/green sputum different to pre-op
  5. Infection on sputum culture report
  6. Unexplained high white cell count or prescription of antibiotic for respiratory infection
  7. New abnormal breath sounds
  8. Physician diagnosis of PPC
31
Q

What are the 5 risk factors for PPC?

A
  1. Duration of anaesthesia >180 mins
  2. Surgery site (upper abdominal)
  3. Current smoker
  4. Respiratory co-morbidity
  5. Low fitness
32
Q

What are the effects of UAS on lung volume?

A 
Causes a restrictive ventilatory pattern
Decreases
- FRC
- Tidal volume
- Inspiratory capacity
- Vital capacity
33
Q

What causes reduced lung volume following UAS?

A
  • Anaesthesia
  • Analgesia
  • Pain
  • Diaphragm splinting
  • Posture
  • Mucus pooling
  • Not being mobile
34
Q

Why does anaesthesia cause reduced lung volume?

A
  • Reduced phrenic nerve & diaphragm function
  • Depressed hypercapnic drive & hypoxaemic response
  • Supine posture
35
Q

Why does analgesia cause reduced lung volume?

A

Decreases

  • Respiratory drive
  • Periodic sighs
  • Cough reflex
  • Breathing pattern
  • Alveolar ventilation
36
Q

Why does diaphragm splinting cause reduced lung volume?

A
  • 60% reduction in diaphragm excursion

- Upper chest pattern of breathing

37
Q

What are the consequences of reduced lung volume?

A
  • Atelectasis

- Hypoxaemia (PaO2 < 80mmHg, SpO2 < 97%)

38
Q

What auscultation findings can be expected in the presence of lung collapse?

A
  • Reduced breath sounds
  • Fine end inspiratory crackles
  • Bronchial breath sounds
39
Q

What are the signs of hypoxaemia?

A
  • Restlessness
  • Confusion
  • Sweating
  • Tachycardia
  • Hypertension
  • Cyanosis
40
Q

What is compliance?

A

Volume change per unit pressure change

CI1 (21 decks)

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