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Developmental/Neonatal Physiology > Session 5: Oxygenation > Flashcards

Session 5: Oxygenation Flashcards

1
Q

What are the forms of oxygen in the blood?

A

Plasma and hemoglobin

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2
Q

What is the linear relationship of oxygen in plasma?

A

Increase in FiO2 yields an increase in PaO2

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3
Q

What kind of relationship is hemoglobin in the blood?

A

Non-linear

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4
Q

How many mol of O2 can bind to hemoglobin?

A

4

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5
Q

How many ml of O2 can a fully saturated hemoglobin molecule carry?

A

1.34ml

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6
Q

What is the amount of oxygen carried by hemoglobin dependent on?

A

Concentration of hemoglobin and degree of saturation

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7
Q

Does HbF bind to 2,3 DPG?

A

No

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8
Q

What is a result of HbF not binding to 2,3 DPG?

A

Left shift in oxyhemoglobin curve and Hg holds on to O2

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9
Q

What are factors that shift the curve right?

A

Decreased PH, increased CO2, increased H ions, and increased temperature

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10
Q

What is the result of a right shift?

A

Decreased Hg affinity for O2

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11
Q

What are factors that shift the curve left?

A

Presence of HgF, decreased 2,3 DPG, alkalosis, decreased PCO2, and decreased temperature

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12
Q

What is ventilation in the neonate?

A

Elimination of CO2

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13
Q

What is oxygenation in the neonate?

A

O2 uptake

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14
Q

What is FRC?

A

Functional residual capacity, 30cc/kg in neonate

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15
Q

What is FiO2?

A

Fraction of inspired O2, measured in %, and RA has .21% O2

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16
Q

What is PaO2?

A

Partial pressure of O2
Amount of O2 dissolved in arterial blood
Expressed in units of Torr of mmHg
Acceptable limits for newborn 50-80 mmHg

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17
Q

What is PAO2?

A

Partial pressure of O2 in alveolar gas
Actual number of O2 molecules available for diffusion into pulmonary capillary
Sum of partial pressure of all gases in alveoli=barometric pressure (760mmHg)

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18
Q

What is the formula for PAO2?

A

Barometric pressure - Partial pressure of water vapor X Fi)2 in dry air

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19
Q

What is PAO2 in room air at sea level?

A

(760-47) X .21 = 150 mmHg

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20
Q

What is the ratio of CO2 excretion to O2 uptake?

A

0.8

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21
Q

What is the final alveolar air equation?

A

PAO2 = [(BP-47) (FiO2)] - PaCO2/R

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22
Q

What is the result of normal breathing?

A

Inspiration: contraction of respiratory muscles

Enlargement of intrathoracic space

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23
Q

What is expiration?

A

Passive event
Respiratory muscles relax
Lung and rib care return to resting state
Amount of gas drawn through nose of ETT during a single cycle of ventilation is called Tidal Volume

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24
Q

What is a normal Tidal Volume?

A

6-9 mL per kg, FRC > TV

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25
Q

What is minute ventilation?

A

Tidal Volume in mL X number of breaths per minute or respirator frequency

26
Q

What is alveolar minute ventilation?

A

(Tidal volume - dead space) X frequency

27
Q

What is dead space?

A

Amount of air not available for respiration

28
Q

What are the characteristics of the neonatal rib cage?

A

More cylindrical then elipsiod

Ribs more horizontal than oblique

29
Q

What can be associated/affect respiratory failure?

A

Food substrate: muscle fatique
Hypoxia
Elastic recoil: surfactant interface, ability of respiratory muscles to relax (FRC)

30
Q

What will happen with a high FRC?

A

Overexpansion

31
Q

What will happen with a low FRC?

A

Atelectasis

32
Q

What is the Law of LaPlace?

A

Pressure needed to inflate the lung is 2X the surface tension & is inversely proportional to the radius of the structure (P=2st/r)

33
Q

What facilitates recoil of lungs at end of inspiration, decreases surface tension, and allows for low surface tension when lung volume is decreased to prevent collapse?

A

Surfactant

34
Q

What is grunting?

A

Increase FRC, High ventilator settings a first, once open need less pressure

35
Q

What is compliance?

A

Relationship between change in Volume and change in Pressure: increase pressure=decrease volume and decrease pressure=increase volume

36
Q

What can changes in compliance cause?

A

Nasal flaring, grunting, retractions, and color changes

37
Q

What factors influence compliance?

A 
Number of alveoli
Surfactant
Interstitial changes
V/Q mismatch
Lung Volume
38
Q

What is V/Q matching?

A

Matching of ventilation and perfusion

39
Q

What is the ratio when ventilation is matched to perfusion?

A

1

40
Q

What causes low lung volume?

A

Pulmonary hypoplasia
Surfactant deficiency
extrinsic lung restriction
intrinsic lung restriction

41
Q

What are clinical uses of CPAP or PEEP?

A

Correct atelectasis
Increase FRC
Improve V/Q mismatch
Improve pulmonary edema

42
Q

What is resistance?

A

Amount of pressure needed to move respiratory gases through the airway at a constant flow rate

43
Q

What does resistance depend on?

A

Lung tissue resistance of viscosity
Flow or airway resistance
Change in pressure / Change in flow

44
Q

What is the % of tissue resistance in newborns?

A

40%

45
Q

What is the tissue resistance due to in newborns?

A

Increased pulmonary interstitial fluid
C-section
Early stage RDS
Pulmonary hyperperfusion

46
Q

Airway resistance is determined by what?

A

Flow rates
Length of connecting tubing
Inner diameter of airways
Physical properties of gas

47
Q

What is the time constant?

A

How long it takes for the lungs to inflate and deflate

Time constant = Resistance X Compliance

48
Q

What is 1 time constant?

A

The time needed for alveolar pressure to reach 63% of the change in airway pressure

49
Q

What is 3 time constants?

A

The time needed for alveolar pressure to reach 95% of the change in airway pressure

50
Q

What is the time constant in a healthy infant?

A

0.15 sec

51
Q

What happens if I-time is too short?

A

Incomplete tidal volume may be delivered

52
Q

What happens if E-time is too short?

A

Incomplete expiration
Increased FRC
Inadvertent PEEP

53
Q

What is MAP?

A

Average pressure to which the lungs are exposed during the respiratory cycle
MAP = (area under the pressure/time curve) / time of one ventilator cycle

54
Q

What other than FiO2 determines oxygenation?

A

MAP

55
Q

What is the oxygen index?

A

Useful indicator for the severity of respiratory distress

OI > 15 indicates sever respiratory compromise

56
Q

What is PIP?

A

Pressure you set to deliver inspired volume

57
Q

What are advantages of PIP < 30?

A

Less BPD, normal lung development

58
Q

What are disadvantages of PIP < 30?

A

Insufficient ventilation
Low PaO2
Atelectasis

59
Q

What are advantages of > 30 PIP?

A

Re-expanded atelectasis
Increased PaO2
Decreased PaCO2
Decreased pulmonary vascular resistance

60
Q

What are disadvantages of > 30 PIP?

A

BPD
May impede venous return
May decrease cardiac output

Developmental/Neonatal Physiology (4 decks)

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