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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
What is minute ventilation?
Tidal Volume in mL X number of breaths per minute or respirator frequency
26
What is alveolar minute ventilation?
(Tidal volume - dead space) X frequency
27
What is dead space?
Amount of air not available for respiration
28
What are the characteristics of the neonatal rib cage?
More cylindrical then elipsiod | Ribs more horizontal than oblique
29
What can be associated/affect respiratory failure?
Food substrate: muscle fatique Hypoxia Elastic recoil: surfactant interface, ability of respiratory muscles to relax (FRC)
30
What will happen with a high FRC?
Overexpansion
31
What will happen with a low FRC?
Atelectasis
32
What is the Law of LaPlace?
Pressure needed to inflate the lung is 2X the surface tension & is inversely proportional to the radius of the structure (P=2st/r)
33
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?
Surfactant
34
What is grunting?
Increase FRC, High ventilator settings a first, once open need less pressure
35
What is compliance?
Relationship between change in Volume and change in Pressure: increase pressure=decrease volume and decrease pressure=increase volume
36
What can changes in compliance cause?
Nasal flaring, grunting, retractions, and color changes
37
What factors influence compliance?
``` Number of alveoli Surfactant Interstitial changes V/Q mismatch Lung Volume ```
38
What is V/Q matching?
Matching of ventilation and perfusion
39
What is the ratio when ventilation is matched to perfusion?
1
40
What causes low lung volume?
Pulmonary hypoplasia Surfactant deficiency extrinsic lung restriction intrinsic lung restriction
41
What are clinical uses of CPAP or PEEP?
Correct atelectasis Increase FRC Improve V/Q mismatch Improve pulmonary edema
42
What is resistance?
Amount of pressure needed to move respiratory gases through the airway at a constant flow rate
43
What does resistance depend on?
Lung tissue resistance of viscosity Flow or airway resistance Change in pressure / Change in flow
44
What is the % of tissue resistance in newborns?
40%
45
What is the tissue resistance due to in newborns?
Increased pulmonary interstitial fluid C-section Early stage RDS Pulmonary hyperperfusion
46
Airway resistance is determined by what?
Flow rates Length of connecting tubing Inner diameter of airways Physical properties of gas
47
What is the time constant?
How long it takes for the lungs to inflate and deflate | Time constant = Resistance X Compliance
48
What is 1 time constant?
The time needed for alveolar pressure to reach 63% of the change in airway pressure
49
What is 3 time constants?
The time needed for alveolar pressure to reach 95% of the change in airway pressure
50
What is the time constant in a healthy infant?
0.15 sec
51
What happens if I-time is too short?
Incomplete tidal volume may be delivered
52
What happens if E-time is too short?
Incomplete expiration Increased FRC Inadvertent PEEP
53
What is MAP?
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
What other than FiO2 determines oxygenation?
MAP
55
What is the oxygen index?
Useful indicator for the severity of respiratory distress | OI > 15 indicates sever respiratory compromise
56
What is PIP?
Pressure you set to deliver inspired volume
57
What are advantages of PIP < 30?
Less BPD, normal lung development
58
What are disadvantages of PIP < 30?
Insufficient ventilation Low PaO2 Atelectasis
59
What are advantages of > 30 PIP?
Re-expanded atelectasis Increased PaO2 Decreased PaCO2 Decreased pulmonary vascular resistance
60
What are disadvantages of > 30 PIP?
BPD May impede venous return May decrease cardiac output

Developmental/Neonatal Physiology (4 decks)

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