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Pulmonology > Ventilation Disorders > Flashcards

Ventilation Disorders Flashcards

1
Q

What is Odines Curse?

  • etiology
  • when is this worse?
A

-primary alveolar hypoventilation (inadequate alveolar ventilation)

  • etiology:
  • congenital or severe trauma/insult to the brainstem
  • central nervous system failure

-hypoventilation is worse during sleep

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2
Q

Patient Profile of Primary alveolar hypoventilation

A
  • usually non-obese
  • males in 3rd or 4th decade of life
  • lethargy, HA, adn somnolence
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3
Q

Physical exam findings of pt with Primary alveolar hypoventilation

A
  • no dyspnea
  • cyanosis
  • evidence of pulm HTN (develops 2ndry to chronic hypoxemia)
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4
Q

Primary Alveolar Hypoventilation Work up to find causes of hypoventilation

A
  • labs (Chem, TSH, CBC, ABG)
  • CXR
  • Brain CT/MRI (R/O stroke/tumor)
  • Echo (right heart changes from chronic hypoxemia)
  • PFTs (can include negative inspiratory pressure to rule out neuromuscular disease
  • Muscle stimulation tests/nerve conduction velocity to R/O neuromuscular dx
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5
Q

Tx primary alveolar hypoventilation

A
  • supplemental O2
  • positive pressure ventilation (tracheostomy at night or positive pressure mask)
  • respiratory stimulants (not very effective but may be worth a try)
  • -medroxyprogesterone
  • acetazolamide
  • theophylline

-diaphragm pacing w/ phrenic nerve stimulation

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6
Q

Pickwickian Syndrome

-what is this?

A

-blunted ventilatory drive and increased mechanical load imposed upon the chest by obesity.

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7
Q

Tx of Pickwickian syndrome

A
  • weight loss
  • Noninvasive positive pressure ventilation (BIPAP & CPAP)
  • Tracheostomy
  • respiratory stimulants (theophylline, acetazolmide; these are best used in babies because they are not well developed)
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8
Q

Hyperventilation Syndromes

  • what is it?
  • causes
A

What is this?
-increase in alveolar ventilation that leads to decreased CO2

Causes

  • brainstem injury
  • pregnancy
  • hypoxemia
  • lung dz
  • sepsis
  • liver failure
  • fever
  • pain
  • anxiety
  • hyperthyroidism
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9
Q

Signs and sx of acute hyperventilation

A
  • Rapid respiratory rate
  • paresthesias
  • carpopedal spasm
  • tetany
  • anxiety
  • arrhythmias
  • cerebral vasoconstriction and cerebral ischemia
  • seziures
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10
Q

Tx of Acute Hyperventilation

A
  • treat underlying cause
  • rebreathing expired gas from a paper bag
  • pursed lip breathing
  • anxiolytic drugs
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11
Q

Chronic Hyperventilation

-signs and sx

A
  • fatigue
  • dyspnea
  • anxiety
  • palpitations
  • dizziness
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12
Q

Obstructive sleep apnea (OSA)

-who is this most common in?

A

-most common in young (less than 35) African american males

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13
Q

what type of pt is genetically more likely to develop sleep apnea?

A
  • pts with down syndrome because they have a fat tongue.
  • people with weird structured chin and jaws
  • remember, if a child snores there is most likely obstruction going on.
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14
Q

Obstructive sleep apnea is caused from?

A

-recurrent collapse of the pharyngeal airway during sleep;

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15
Q

Pathophysiology of OSA

A
  • cessation of airflow

- disturbances in gas exchange, hypoxia, increased catecholamie release, increased BP and HR, poor sleep quality

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16
Q

Risk factors OSA

A
  • obesity
  • advancing age
  • smoking
  • craniofacial or upper airway soft tissue abnormalities
  • nasal congestion
  • pregnancy
  • end stage renal dz
  • CHF
  • chronic lung dz
  • fmaily hx
  • menopause
  • hypothyroidism
17
Q

Patient factors associated with a high likelihood of sleep apnea

A
  • neck circumference greater than 43cm men and 37cm in women
  • narrowing of lateral airway walls
  • enlarged tonsils (3+ 4+)
18
Q

Signs and Sx that are suspicious for sleep apnea

A
  • HTN
  • excessive daytime solmnolence
  • morning sluggishness
  • AM HA
  • daytime fatigue
  • impotence*
  • Obesity*
  • Loud snoring
  • poor judgement
  • memory impairment
  • falling asleep while driving
19
Q

Complications of OSA

A
  • MVA
  • High users of medical resources (Insulin resistance, DM)
  • CVD (HTN, Pulm HTN, CAD, CHF, CVA)
  • Increased risk of perioperative complications
  • -2-3x increased risk of all cause mortality
20
Q

Dx of OSA

A
  • Lab tests, TSH, RBC (looking for polycythemia)
  • polysomnography (sleep study)
  • Home testing
  • home overnight oximetry (cannot dx with this but if their overnight oximetry is good they probably dont have OSA
21
Q

Define

  • apnea
  • hypopna
  • Apnea-hypopnea index
  • respiratory disturbance index
A

Apnea: breathing cessation for at least 10 sec with decrease in O2 sat.

Hypopnea: decreased airflow iwth drop in O2 sat of at least 4%

APnea-hypopnea: the number of combined events per hour

RDI: number of apneas, hypopneas, and respiratory effort related arousals per hour of sleep

22
Q

What is all tested in a polysomnography (sleep study)

A
  • EEG (tells us what stage of sleep they are in)
  • Electro-oculography (Checks muscle tension and movement of the eye, rapid eye movement in REM)
  • EMG (place on face muscle, describes muscle tone)
  • EKG
  • Pulse oximetry
  • respiratory effort
  • airflow

*respiratory effort with cessation of airflow in nose and mouth = sleep apnea.

apnea with no respiratory effor and no obstrutcion = central sleep apean from CNS

23
Q

*respiratory effort with cessation of airflow in nose and mouth =_____.

apnea with no respiratory effort and no obstrutcion =____.

A

sleep apnea

central sleep apnea

24
Q

Respiratory Disturbance Index

  • mild sleep apnea
  • moderate sleep apnea
  • sever sleep apnea
A
  • mild: 5-14/hr
  • moderate: 15-29/hr

-severe: greater than 30/hr
(you have stopped breathing and woke up to a later sleep stage 30x/hr

25
Q

Tx OSA

A
  • weight loss
  • sleep positioning
  • avoid resp suppressants (ETOH/narcotics)
  • CPAP** (MAIN, doesnt work for Central sleep apnea)
  • BiPaP (if central sleep apnea)
  • oral dental appliances
  • surgery (uvulopalatophasryngoplasty)
26
Q

What is the difference between CPAP and BIPAP?

A

CPAP:

  • continuous positive airway pressure
  • standard tx for OSA

BIPAP:

  • non-invasive positive pressure ventilation
  • for use when taking a deep breath is difficult
  • lower pressure for exhalation and higher pressure for inhalation.
  • can have “back up rate”
  • used for mixed (central and obstructive) sleep apnea and also for impending respiratory failure
27
Q

Central Sleep apnea

  • how does this differ from OSA
  • common in what pt
A

-no ventilatory effor seen during episodes of apnea because brain forgets to tell body to breathe.

Common in premature infants, post stroke, TBI, and CHF.

28
Q

Conditions that may be associated with central sleep apna

A
  • CHF
  • hypothyroid dz
  • kidney failure
  • neurologic dz (parkinsons, alzheimers, als)
  • damage to the brainstem caused by encephalitis, stroke, injury, etc.

Pulmonology (15 decks)

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