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Respiratory > Ventilation > Flashcards

Ventilation Flashcards

1
Q

Minute ventilation?

A

volume of air expired in one minute (VE) or per minute

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2
Q

Respiratory rate?

A

Rf

frequency of breathing per minute

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3
Q

Alveolar ventilation

A

Valv

volume of air reaching the respiratory zone per minute

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4
Q

Respiration?

A

process of generating ATP either with excess oxygen (aerobic) or shortfall (anaerobic)

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5
Q

Alveolar dead space?

A

capacity of airways that should be able to undertake gas exchange but cannot (e.g. hypoperfused alveoli)

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6
Q

Physiological dead space?

A

equivalent to the sum of alveolar and anatomical dead space

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7
Q

Anatomical dead space?

A

capacity of the airways incapable of undertaking gas exchange

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8
Q

Hypoventilation?

A

deficient ventilation of lungs
unable to meet metabolic demand
increase PO2 - acidosis

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9
Q

Hyperventilation?

A

excessive ventilation of the lungs
atop of metabolic demand
leads to reduced PCO2 - alkalosis

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10
Q

Hyperpnoea

A

increased depth of breathing to meet metabolic demand

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11
Q

Hypopnoea

A

decreased depth of breathing (inadequate to meet metabolic demand)

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12
Q

Apneoa

A

cessation of breathing

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13
Q

Dyspnoea

A

difficulty in breathing

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14
Q

Bradypnoea

A

slow BR

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15
Q

Tachypnoea

A

fast BR

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16
Q

Orthopnoea

A

positional difficulty in breathing (when lying down)

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17
Q

Ventilation

A

amount of air going in and out of the body in relation to what the body needs

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18
Q

Why does exercise not cause hyperventilation?

A

causes hyperpnoea and tachypnoea

breathing is at increased rate and depth but to match requirement

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19
Q

Tidal volume

A

amount of air breathing in and out per breath
0.5L normal
increases with exercise

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20
Q

Inspiratory reserve volume

A

amount of extra volume you can breathe in

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21
Q

Expiratory reserve volume

A

amount of extra air you can breathe out

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22
Q

Residual volume

A

volume of air left in lungs after maximum expiration

beneficial to prevent lungs entirely collapsing on themselves

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23
Q

Functional residual capacity

A

amount of air left in lungs after normal expiration

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24
Q

Total lung capacity

A

total amount of air that can fill the lungs

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25
Q

Vital capacity

A

how much air in the lungs that you can influence

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26
Q

Inspiratory capacity

A

how much air can be taken in from neutral position

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27
Q

What 5 factors affect lung volumes and capacities?

A 
Body size (height and shape)
Sex 
Disease (pulmonary or neurological) - affect control, tone of muscles, emphysema 
Age (chronological, physiological)
Fitness (innate, training)
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28
Q

How does height affect lungs?

A

taller people have bigger lungs

fatter people dont necessarily have bigger lungs as obesity is on outside of thorax

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29
Q

How does sex affect height?

A

males have larger lungs

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30
Q

How does inheritance affect lungs?

A

inherited fitness

larger barrel shaped chest with large lungs to promote faster gas exchange

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31
Q

What is the conducting zone?

A 
16 generations (bifurcations)
no gas exchange
typically 150ml in adults at FRC 
= anatomical dead space (not meant for gas exchange)
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32
Q

What is the non perfused parenchyma?

A 
generation 23
alveoli without a blood supply
no gas exchange
typically 0ml in adults
= alveolar dead space
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33
Q

What is the respiratory zone?

A

7 generations
gas exchange
typically 350ml in adults
= air reaching here is equivalent to alveolar ventilation

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34
Q

What reversible procedures can decrease dead space?

A

tracheostomy

cricothyrocotomy

35
Q

What reversible procedures can increase dead space?

A

anaesthetic circuit

snorkelling

36
Q

What irreversible process increases dead space?

A

smoking

37
Q

Why is it hard to breathe deep under water?

A

hydrostatic pressure increases with depth

harder to breathe deeper down

38
Q

What two laws govern the increase in TV deeper underwater?

A

Poiseuille’s Law – radius makes a big difference
Decreased resistance - more effort needed to breathe

Boyle’s Law – pressure and volume are inversely proportional

Increasing the ambient pressure causes volume to decrease

39
Q

What does tidal breathing involve?

A

pressure changes

40
Q

Describe stages of tidal breathing?

A
  1. FRC air in lungs
  2. Inspiratory muscles activated to expand lung tissue creating a negative pressure
  3. Alveolar pressure inside the lung decreases
  4. Pressure gradient
  5. Air flows in
  6. Airs flows in with inspiratory effort applied till both pressures balance out
  7. Airs stops flowing
  8. Remove inspiratory effort
  9. Pressure becomes more positive
  10. lungs compress air and pushes air out
  11. till net change in volume reversed
41
Q

Ambient pressure?

A

0cm of water IDEAL

or 160kPa
or 760mmHg
or 1atm

42
Q

Where does TV start and end?

A

at FRC

43
Q

Tendency of chest wall and lung?

A

chest wall tends to spring forward
lung had tendency to recoil inwards
both units work together

BUT chest recoil = lung recoil
the forces are in equilibrium at end tidal expiration (FRC)

44
Q

What allows us to change things in the lungs?

A

muscle effort

INSPIRATION inspiratory muscle effort + chest recoil > lung recoil

EXPIRATION
chest recoil < lung recoil + expiratory muscle effort

45
Q

What is the neutral position of the intact chest?

A

FRC

46
Q

What are the lungs surrounded by?

A

visceral pleural membrane

47
Q

What is inner chest surface covered by?

A

parietal pleural membrane

48
Q

What is the pleural cavity?

A

gap between pleural membranes
fixed volume
contains protein rich pleural fluid

double folded layer that allows lots of dynamic movement in this space

49
Q

How does haemothorax affect lung?

A

vessel bleed in pleural cavity
compress lung
give lung less space to expand and fill with air

50
Q

How does pneumothorax affect lung?

A

perforated chest wall also caused by punctured lung
allows air in space
breaks vacuum
interrupts ability of lung to work as single unit

51
Q

What is negative pressure breathing?

A

lower Palv to below Patm to create a pressure gradient

52
Q

What is positive pressure breathing?

A

Patm is increased above Palv - create negative pressure

rescue breaths (mouth to mouth)
ventilators
fighter pilots

53
Q

Three compartment model?

A

visualise pressure in the lung
Palv = 0cmH2O
Patm = 0cmH2O
Ppl = -5cmH20

54
Q

Why is intrapleural pressure negative?

A

not equal along length of lung

under negative pressure - lungs recoil in, chest recoil out

55
Q

What is the transmural pressure?

A

Pinside - Poutside

transpulmonary pressure (Ptp)
pressure inside alveoli - pressure in intrapleural space

transthoracic pressure (Ptt) pressure in intrapleural space - pressure in atmosphere

transrespiratory system pressure (Pts)

56
Q

What dictates air flow?

A

Pts transrespiratory system pressure

if positive air flows in
if negative air flows out

57
Q

What force is the diaphragm?

A

unidirectional force
pulling force
contraction - pulls down

used mostly for quiet breathing

58
Q

What force do the ribs exert?

A

inhalation - upwards and outwards

59
Q

Why is change in volume for same change in pressure reduced at extremes of volume?

A

at middle of lung volumes
less effort to change things
at higher/lower lung volumes, significantly higher pressures must be applied to change things

60
Q

What happens at high extremes?

A

plateau
regardless of extra pressure added, cannot deflate or inflate the lungs further

here changes in pressure no longer generate change in air flow

61
Q

What does the independent chest wall and lung lines show?

A

distance between the two is the same

intact lung line is a product of the other 2

62
Q

What does spirometry produce?

A

volume time curve

63
Q

Why do you wear a noseclip?

A

measure air flow through mouth

64
Q

How is spirometry performed?

A
  1. noseclip
  2. patient inhales to TLC
  3. patient exhales as hard and fast as possible till RV reached / 6s gone
65
Q

What does volume time curve test for?

A

FVC

airway resistance

66
Q

What does the FEV1/FVC ratio show?

A

compares how much air coming out in 1 sec

normal 73%
restrictive 97%
obstructive 53%

67
Q

What happens in person with restrictive lung disease?

A

reduced ability of lung to fill
FEV1/FVC ratio increases
empty almost all air in 1 second

68
Q

What happens in person with obstructive lung diseases?

A

reduced ability to inspire and expire

FEV1/FVC ratio decreases

69
Q

What do you look for in spirometry curve?

A

Slow starts
Early stops
Intramanouever variability

70
Q

How is a peak flow test performed?

A
  1. noseclip
  2. patient inhales to TLC and exhales hard and fast
  3. do not need to reach RV
  4. repeat 2x and take highest measurement
71
Q

What is peak flow used for typically?

A

asthma

72
Q

How is peak flow assessed?

A

compare to reference values

73
Q

How to calculate peak expiratory flow rate?

A

USE SMALLEST DENOMINATION OF TIME

e.g. 0.2s (2L) x 5 x 60

74
Q

Why might spirometry trace decrease straight away?

A

reflex to fill lungs as soon as emptied

75
Q

How is a flow-volume loop performed?

A
  1. noseclip
  2. one tidal breath (A, B)
  3. inhale steadily to TLC
  4. exhale as hard and fast as possible
  5. continue exhalation until RV
  6. inhale again to TLC
76
Q

What is inspected on flow volume loop?

A

Visually inspect performance and volume time curve and repeat if necessary. Look out for:
Inconsistencies with clinical picture
Interrupted flow data

77
Q

What does peak flow test?

A

tests airway resistance (how fast can air be expired?)

78
Q

What do flow volume loops test?

A

tests airway resistance, flow rates, TV, IRV, ERV and FVC

79
Q

What is the pleural cavity physiologically?

A

partial vacuum

80
Q

What predominantly induces tidal breathing?

A

diaphragm

81
Q

What does maximum ventilation involve?

A

full inspiratory muscle recruitment

82
Q

How might recovery from burns affect lung volumes capacities?

A

most reduced

scar tissue formed
less elastic
restrict chest expansion at most volumes

83
Q

How does intrapleural pressure change at start of tidal inspiration?

A

small decrease

diaphragm contracts and pulls down (external intercostals may contract to pull ribs up and out)
pulls parietal pleural membrane away from lung
stretches intrapleural space as lungs fill

lung tries to recoil in so visceral pleura pulled in and this increases the partial vacuum from -5 to -8cmH2O

Respiratory (7 decks)

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