Lung mechanics with mechanical Ventilation

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Questions and Answers

Specifically, when a patient fails to ______ or oxygenate adequately, the problem may be caused by one of six pathophysiological factors.

ventilate

In mechanical ventilation, the degree of airway resistance is primarily affected by the length, size, and patency of the airway, ______ tube, and ventilator circuit.

endotracheal

Impedance to ventilation by the movement of gas through the airways is called ______ resistance.

airway

Airway resistance accounts for approximately 80% of the ______ resistance to ventilation.

<p>frictional</p> Signup and view all the answers

A change in the caliber of an airway by a factor of 2 causes a ______-fold change in resistance.

<p>sixteen</p> Signup and view all the answers

The normal Raw is 0.5 to 2.5 cmH2O/L/______.

<p>sec</p> Signup and view all the answers

1/3 of the total work of breathing is attributable to ______ resistance to gas and tissue movement.

<p>frictional</p> Signup and view all the answers

Raw = (PIP - Plateau) / Vi (______ Flow)

<p>Inspiratory</p> Signup and view all the answers

[Blank] compliance is volume change (lung expansion) per unit pressure change (work of breathing).

<p>Lung</p> Signup and view all the answers

[Blank] compliance is the change in volume for any given applied pressure.

<p>Static</p> Signup and view all the answers

[Blank] lung compliance is the compliance of the lung at any given time during actual movement of air.

<p>Dynamic</p> Signup and view all the answers

Low compliance indicates a ______ lung (one with high elastic recoil) and can be thought of as a thick balloon; e.g. fibrosis.

<p>stiff</p> Signup and view all the answers

High compliance indicates a ______ lung (one with low elastic recoil) and can be thought of as a grocery bag; e.g. emphysema.

<p>pliable</p> Signup and view all the answers

Correct Vt = Expired Vt - ______ Volume.

<p>Tubing</p> Signup and view all the answers

Abnormally low or high lung ______ impairs the patient's ability to maintain efficient gas exchange.

<p>compliance</p> Signup and view all the answers

Low compliance typically makes lung ______ difficult.

<p>expansion</p> Signup and view all the answers

Compliance is highest at ______ lung volumes, and much lower at volumes which are very low or very high.

<p>moderate</p> Signup and view all the answers

High compliance induces incomplete ______ and CO2 elimination.

<p>exhalation</p> Signup and view all the answers

In many clinical situations (e.g., atelectasis), low lung compliance is responsible for ______ hypoxemia.

<p>refractory</p> Signup and view all the answers

High compliance measurements are usually related to conditions that increase the patient's functional ______ capacity.

<p>residual</p> Signup and view all the answers

Static compliance is measured when there is no air flow (using the ______ Pressure - PEEP).

<p>Plateau</p> Signup and view all the answers

When air flow is absent, airway resistance is not a determining factor. Thus, static compliance reflects the ______ resistance of the lung and chest wall.

<p>elastic</p> Signup and view all the answers

Dynamic compliance is measured when air flow is present (using the Peak Airway ______-PEEP).

<p>Pressure</p> Signup and view all the answers

Dynamic compliance therefore reflects the condition of airway resistance (non-elastic resistance) as well as the ______ properties of the lung and chest wall (elastic resistance).

<p>elastic</p> Signup and view all the answers

The ______ Point is where the lungs over come the initial pressure to fill the lung.

<p>Inflection</p> Signup and view all the answers

When the lungs stop expanding but pressure is increased as the gas continues to be pushed in is known as the ______ Point.

<p>Deflection</p> Signup and view all the answers

[Blank] depends on the size of the subject and his or her metabolic rate

<p>Minute ventilation</p> Signup and view all the answers

Estimation of wasted ______ is key in assessing the efficiency of ventilation.

<p>ventilation</p> Signup and view all the answers

[Blank] space can be subdivided into the following two components: anatomical dead space and alveolar dead space.

<p>Dead</p> Signup and view all the answers

The volume of the conducting airways is called the ______ dead space, and averages about 1 ml per pound of Ideal Body Weight.

<p>anatomical</p> Signup and view all the answers

Some alveoli may not participate in gas exchange. These alveoli are ventilated but not ______ with the blood.

<p>perfused</p> Signup and view all the answers

An example is a ______ embolism. This obstructs perfusion to ventilated alveoli, creating alveolar dead space.

<p>pulmonary</p> Signup and view all the answers

The ______ of ventilation depends on the volume of fresh gas reaching the alveoli (Va).

<p>efficiency</p> Signup and view all the answers

The sum of anatomical and alveolar dead space is called ______ dead space.

<p>physiological</p> Signup and view all the answers

Physiological dead space includes both the normal and abnormal components of ______ ventilation

<p>wasted</p> Signup and view all the answers

[Blank] without perfusion is the amount of wasted ventilation.

<p>Ventilation</p> Signup and view all the answers

Normal VD/VT = 20 to 40% and as high as 60% for some ______ patients.

<p>vent</p> Signup and view all the answers

The Bohr equation is used to figure ______ dead space

<p>Physiological</p> Signup and view all the answers

Auto-______ Occurs when there is not enough time for exhalation

<p>PEEP</p> Signup and view all the answers

Corrected auto-______ can assist with ventilation.

<p>PEEP</p> Signup and view all the answers

Patients who require mechanical ventilation often develop ventilatory failure or ______ failure, or both.

<p>oxygenation</p> Signup and view all the answers

When patients on mechanical ventilation fail to ventilate or oxygenate adequately, the issue may stem from one of six ______ factors.

<p>pathophysiological</p> Signup and view all the answers

[Blank] is defined as airflow obstruction in the airways.

<p>airway resistance</p> Signup and view all the answers

In mechanical ventilation, the degree of airway resistance is primarily determined by the length, size, and patency of the airway, endotracheal tube, and ______ circuit.

<p>ventilator</p> Signup and view all the answers

Gas flow through the airways also causes ______ resistance, which contributes to overall airway resistance.

<p>frictional</p> Signup and view all the answers

The normal range for Raw (airway resistance) is 0.5 to 2.5 cmH2O/L/sec, indicating typical ______ in the airway.

<p>impedance</p> Signup and view all the answers

Approximately 1/3 of the total work of breathing is attributable to ______ resistance to gas and tissue movement.

<p>frictional</p> Signup and view all the answers

Raw can be calculated using the formula: Raw = (PIP - Plateau) / ______, where Vi represents inspiratory flow.

<p>Vi</p> Signup and view all the answers

[Blank] compliance is defined as volume change per unit pressure change and measures the ______'s ability to stretch and expand.

<p>lung</p> Signup and view all the answers

In clinical practice, lung compliance is separated into two measurements: static compliance and ______ compliance.

<p>dynamic</p> Signup and view all the answers

[Blank] ______ compliance is the change in volume for any given applied pressure when there is no air flow.

<p>static</p> Signup and view all the answers

Low compliance indicates a ______ lung (one with high elastic recoil) and can be associated with conditions like fibrosis.

<p>stiff</p> Signup and view all the answers

High compliance indicates a ______ lung (one with low elastic recoil) and can be associated with conditions like emphysema.

<p>pliable</p> Signup and view all the answers

Conditions like atelectasis often result in low lung compliance, which can lead to ______ hypoxemia.

<p>refractory</p> Signup and view all the answers

High compliance is often related to conditions that increase the patient's functional residual ______, such as chronic air trapping.

<p>capacity</p> Signup and view all the answers

Static compliance is calculated using the formula: Static Compliance = Corrected Tidal Volume / (Plateau Pressure - ______).

<p>PEEP</p> Signup and view all the answers

Dynamic compliance is calculated using the formula: Dynamic Compliance = Corrected Tidal Volume / (Peak Inspiratory Pressure - ______).

<p>PEEP</p> Signup and view all the answers

The volume of the conducting airways is termed anatomical ______, which averages about 1 ml per pound of Ideal Body Weight.

<p>dead space</p> Signup and view all the answers

If a patient's weight is not specified, a standard value of ______ ml is often assumed for anatomical dead space.

<p>150</p> Signup and view all the answers

[Blank] dead space refers to alveoli that are ventilated but not perfused, hindering gas exchange.

<p>alveolar</p> Signup and view all the answers

A pulmonary ______ is an example of a condition that can cause alveolar dead space by obstructing perfusion to ventilated alveoli.

<p>embolism</p> Signup and view all the answers

The ______ of ventilation depends on the volume of fresh gas reaching the alveoli, which is represented by the formula Va = Vt - Vds.

<p>efficiency</p> Signup and view all the answers

Match the following clinical conditions with the type of airway issue they primarily cause:

<p>COPD = Increased airway resistance due to emphysema and chronic bronchitis Foreign body aspiration = Mechanical obstruction of the airway Laryngotracheobronchitis (Croup) = Infection leading to airway inflammation and obstruction Bronchiectasis = Chronic lung condition causing increased airway resistance</p> Signup and view all the answers

Match the lung condition with its effect on lung compliance:

<p>Pulmonary Fibrosis = Decreased lung compliance, making lungs stiff Emphysema = Increased lung compliance, leading to air trapping ARDS = Decreased lung compliance due to alveolar damage and inflammation Normal Lung = Volume change (lung expansion) per unit pressure change (work of breathing)</p> Signup and view all the answers

Match the values to describe the measurement of normal Raw:

<p>0.5 cmH20/L/sec = Lower Limit of normal Raw 2.5 cmH20/L/sec = Upper Limit of normal Raw Increased Raw = Could be caused by a ET tube that is too small Decreased Raw = Could be caused by aggressive bronchodilator treatment</p> Signup and view all the answers

Match the disease with a cause of decreased compliance:

<p>Atelectasis = Alveolar collapse Tension pneumothorax = Increased pressure in the pleural space Obesity = Restriction of lung expansion Retained Secretions = Blockage of airway and reduced expansion</p> Signup and view all the answers

Match the term with the respiratory phrase:

<p>Plateau Pressure = Measured when there is no airflow Peak Airway Pressure = Measured when airflow is present Static Compliance = Elastic resistance of the lung and chest wall Dynamic Compliance = Condition of airway resistance (non-elastic resistance) as well as the elastic properties of the lung and chest wall</p> Signup and view all the answers

Match the measurement with the appropriate variable:

<p>PIP = Peak Inspiratory Pressure PEEP = Positive End-Expiratory Pressure Raw = Airway Resistance Plt or Pplat = Plateau pressure</p> Signup and view all the answers

Match the value with the appropriate description of Alveolar Ventilation:

<p>Vt = Tidal volume Vds = Dead space ventilation Va = Alveolar Ventilation Ve = Minute Ventilation</p> Signup and view all the answers

Match the anatomical location with the description:

<p>Anatomical Dead Space = Volume of the conducting airways where no gas exchange occurs Alveolar Dead Space = Alveoli that are ventilated but not perfused Physiological Dead Space = Sum of anatomical and alveolar dead space Airways = Where air travels to the alveoli</p> Signup and view all the answers

Match the equation to the application associated:

<p>$Raw = \frac{PIP - Plateau}{Vi}$ = Calculating airway resistance $Static Compliance = \frac {Corrected ; Tidal ; Volume}{(Plateau ; Pressure - PEEP)}$ = Calculating static compliance $Dynamic ; Compliance = \frac{Corrected ; Tidal ; Volume}{(Peak ; Inspiratory ; Pressure - PEEP)}$ = Calculating dynamic compliance $VD/VT = \frac{PaCO_2 - PECO_2}{PaCO_2}$ = Calculating dead space to tidal volume ratio</p> Signup and view all the answers

Match the term to the definition:

<p>Minute Ventilation = The total volume of gas entering or leaving the lungs per minute. Alveolar Ventilation = The amount of air that reaches the alveoli per minute and is involved in gas exchange. Dead Space Ventilation = The volume of air that does not participate in gas exchange. Ideal Body Weight = The approximate weight of a person based on their gender and height.</p> Signup and view all the answers

Match the term:

<p>Shunting = Perfusion without ventilation Deadspace = Ventilation without perfusion Minute Ventilation = Respiratory Rate multiplied by Tidal Volume Compliance = Lung's ability to stretch and expand</p> Signup and view all the answers

Match the scenarios to the description:

<p>Increased Peak Inspiratory Pressure(PIP) = Airway resistance is increasing Increased Plateau Pressure(Pplat) = Lung compliance may decreasing AutoPEEP = Air trapping Decreased ventilation = Oxygenation failure</p> Signup and view all the answers

Match the measurement with the appropiate term:

<p>Normal Compliance = 40 to 60 cmH20 overall Anatomical Dead Space = 1ml per pound of Ideal Body Weight Normal VD/VT = 20 to 40% Normal Alveolar Minute Ventilation = 4-6L/min</p> Signup and view all the answers

Match the terms that describe static compliance:

<p>Static Compliance = Measured without Airflow Plateau Pressure = Used to calculate Static Compliance Expiration port occlusion = Necessary to calculate static compliance PEEP = Is required for ventilator management</p> Signup and view all the answers

Match the condition with associated disease:

<p>Low compliance = Atelectasis Shunting = Poor Gas Exchange Air trapping = COPD High compliance = Destruction of lung tissues</p> Signup and view all the answers

Match the condition with intervention:

<p>Increased Peak airway pressure = Suction patient Incomplete exhalation = Prolong expiratory time Low compliance = Increase PEEP Perfusion without ventilation = AutoPEEP</p> Signup and view all the answers

Match the condition with disease:

<p>Emphysema = Loss of elasticity Pulmonary embolus = Increase alveolar dead space Chronic bronchitis = Inflammation of Bronchials Asthma = Bronchospasm</p> Signup and view all the answers

Match the effect with conditions:

<p>Increased airway resistance = Asthma Air trapping = Emphysema Decreased compliance = Fibrosis Alveolar flooding = ARDS</p> Signup and view all the answers

Match the intervention with effect

<p>Delivering high PEEP = Distend functional Alveoli Bronchodilators = Decrease obstruction to breathing Recruitment maneuvers = Reopen collapsed Alveoli Prone positioning = Improve oxygenation</p> Signup and view all the answers

Match the time stamp with most likely description of airway mechanics:

<p>7am: PIP 27, PLT 23 = Baseline airway mechanics 9am: PIP 31, PLT 24 = Airway resistance may be increasing 11am: PIP 34, PLT 23 = Significant Increased upper airway pressures PIP = Peak inspiratory pressure</p> Signup and view all the answers

Match the location with correct anatomical part:

<p>Alveoli = Small sacks in the lungs where gas exchange occurs Trachea = Main airway that connects the throat to the lungs Bronchi = Branches of the trachea that lead to the lungs Diaphragm = Muscle that helps expand and contract the lungs</p> Signup and view all the answers

Match the phrase with the correct definition:

<p>Ventilation = Movement of air into and out of the lungs Oxygenation = Process of loading oxygen onto hemoglobin molecules Respiration = Exchange of gases between the alveoli and the blood Perfusion = Blood Flow</p> Signup and view all the answers

Match the term with what will occur:

<p>Hyperventilation = Increased elimination of carbon dioxide Hypoventilation = Decreased elimination of carbon dioxide Hypoxia = Reduced oxygen in the tissues Hyperoxia = Increased oxygen in the tissues</p> Signup and view all the answers

Match the disease with definition:

<p>ARDS = Form of lung injury that causes a buildup of fluid in the alveoli Pneumonia = Infection of the lungs that can cause inflammation and fluid accumulation Pneumothorax = Collapse of the lung due to air leaking into the space between the lung and chest wall COPD = Group of lung diseases that block airflow and make it difficult to breathe</p> Signup and view all the answers

Match the action with the respiratory impact:

<p>Suctioning = Removes obstruction from the airway Bronchodilator = Open small airways Positive pressure ventilation = Forces air into the lungs PEEP = Holds open the Alveoli</p> Signup and view all the answers

Match the sign with disease:

<p>Increased respiratory rate = Body compensating for poor gas exchange Accessory muscle use = Increased work of breathing Cyanosis = Lack of oxygen in the blood Altered mental status = Hypoxia or hypercapnia</p> Signup and view all the answers

Match the description with deadspace equation:

<p>Calculate the physiological deadspace in patients using = $V_D/V_T = \frac{P_aCO_2 - P_ECO_2}{P_aCO_2}$ $V_D$ = The volume of gas that does not take part in gas exchange Ideal body weight in pounds = Estimate half of the patient's deadspace Bohr Equation = The most accurate measure of deadspace in a patient</p> Signup and view all the answers

Match the effect in obstructive airway with corresponding condition:

<p>Air trapping = COPD exacerbation Bronchoconstriction = Asthma flare-up Mucus plug = Cystic fibrosis lung decline Increased airway resistance = Bronchitis</p> Signup and view all the answers

Match signs and symptoms of patient with restrictive issues:

<p>Rapid shallow breathing = Reduced lung volume Accessory muscle use = Increased work of breathing Increased respiratory rate = Body compensating for poor gas exchange Hypoxemia = Reduced oxygen levels in blood</p> Signup and view all the answers

Match the ventilator control variable:

<p>Volume Control = Set tidal volume and respiratory rate Pressure Control = Set pressure and respiratory rate FiO2 = Set fraction of oxygen and set for appropriate oxygen saturation PEEP = Set positive end expiratory and help prevent alveolar collapse</p> Signup and view all the answers

Match to describe Alveolar Ventilation:

<p>Alveolar ventilation = The amount of air that reaches the alveoli per minute and is involved in gas exchange Dead space = Volume of air that does not participate in gas exchange Increased dead space = Decreased ventilation to alveoli Spontaneous Ve = Minute ventilation for a patient</p> Signup and view all the answers

Match the intervention to improve oxygenation:

<p>Increase FiO2 = Providing more oxygen in inspired air Increase PEEP = Improve alveolar recruitment Prone Patient = Redistributed blood flow in the lungs Optimize ventilation = Improve gas exchange</p> Signup and view all the answers

Match the definition to parameter:

<p>PIP = Peak airway pressure Pplat = Plateau pressure Vt = Tidal volume Raw = Airway pressure</p> Signup and view all the answers

Match the definition to the volume/ space in the lungs

<p>Tidal volume (Vt) = Volume of a normal breath Anatomical dead space = Volume in conducting airways Airway resistance = Impedance to ventilation Alveolar = Volume of the alveoli where the gas exchange takes place</p> Signup and view all the answers

Match the intervention to improve ventilation:

<p>Suction Airway = Clear obstruction Bronchodilator = Open tight airways Increase Tidal Volume or Respiratory Rate = Increase gas exchange PEEP = Splint open the alveoli</p> Signup and view all the answers

Match the description for assessment on patients on ventilation:

<p>Auscultation = Adventitious breath sounds Work of breathing = Increased use of accessory muscles ABG draw = Look at arterial measures of gas exchange Ventilator graphics = Can show how to manipulate or alter management</p> Signup and view all the answers

Match the reason for alarm trigger in ventilator management:

<p>High Pressure Alarm = Obstruction Low Pressure Alarm = Disconnection Apnea Alarm = Not spontaneous breathing High Respiratory Rate = Patient is compensatory</p> Signup and view all the answers

Match to the description of "Auto PEEP"

<p>Air Trapping = Build of PEEP in the Alveoli Inadequate Expiratory Time = Can lead to breath stacking and air trapping Peak Pressure High = Inability to get air out of the lungs Flow Waveform = Expiratory not return to baseline the inspiratory is initiated.</p> Signup and view all the answers

Match the following clinical conditions with their potential effects on airway resistance:

<p>COPD = Increased airway resistance due to emphysema and chronic bronchitis. Postintubation obstruction = Mechanical obstruction leading to higher airway resistance. Asthma = Elevated resistance due to bronchoconstriction and inflammation. Bronchiolitis = Increased airway resistance due to inflammation and obstruction in small airways.</p> Signup and view all the answers

Match the measurement method with the type of lung compliance it assesses:

<p>Static Compliance = Measured during no airflow (plateau pressure) to reflect elastic resistance. Dynamic Compliance = Measured during airflow (peak pressure) to reflect elastic and non-elastic resistance. Plateau Pressure = Used to assess static compliance when airflow is absent. Peak Inspiratory Pressure = Used to assess dynamic compliance when airflow is present.</p> Signup and view all the answers

Match the following pulmonary dysfunctions with their impact on lung compliance:

<p>Atelectasis = Decreased compliance due to alveolar collapse. ARDS = Reduced compliance due to inflammation and fluid accumulation. Emphysema = Increased compliance due to loss of elastic recoil. Pulmonary Fibrosis = Decreased compliance due to stiffening of lung tissue.</p> Signup and view all the answers

Match the values used to calculate static compliance with their description:

<p>Corrected Tidal Volume = The volume of air delivered by the ventilator, adjusted for tubing compression. Plateau Pressure = The pressure measured during an inspiratory pause, reflecting alveolar pressure. PEEP = The positive end-expiratory pressure, used to keep alveoli open. Static Compliance = Calculation using Corrected Tidal Volume / (Plateau Pressure - PEEP) indicates lung elasticity.</p> Signup and view all the answers

Match the term with their significance in mechanical ventilation:

<p>Inflection Point = Point on a pressure-volume curve where the lungs begin to effectively fill with air. Deflection Point = Point where increasing pressure no longer results in increased lung expansion. Optimal PEEP = Optimal PEEP helps to recruit alveoli and improve gas exchange. Pressure-Volume Loop = Shows the relationship between pressure and volume during ventilation.</p> Signup and view all the answers

Match each term with its definition in respiratory physiology:

<p>Anatomical Dead Space = The volume of the conducting airways where no gas exchange occurs. Alveolar Dead Space = Alveoli that are ventilated but not perfused, preventing gas exchange. Physiological Dead Space = The sum of anatomical and alveolar dead space. Dead Space = Regions of lung ventilated but not perfused.</p> Signup and view all the answers

Match the calculations with their correct results, given a patient with following data: Vt 450, PaCO2 44, PeCO2 22.

<p>PaCO2 PeCO2 = 44 - 22 = 22 (PaCO2 PeCO2) / PaCO2 = 22/44 = 0.5 VD/VT = 0.5 x 100 = 50% Wasted Ventilation = 0.5 x 450 = 225 ml</p> Signup and view all the answers

Match the term with its definition in mechanical ventilation:

<p>Minute Ventilation (Ve) = Volume of air moved in and out of lungs per minute. Tidal Volume (Vt) = Volume of air inspired or expired during each breath. Frequency (f) = Number of breaths per minute. Alveolar Ventilation (Va) = Amount of fresh gas reaching the alveoli.</p> Signup and view all the answers

Match the equations with correct values for Alveolar Ventilation, considering Vt = 550 ml and IBW = 170 lbs.

<p>Anatomical Dead Space (Vds) = 170 ml Alveolar Ventilation (Va) = 550 ml - 170 ml = 380 ml Ve (RR = 12) = 550 ml x 12 = 6.6 L/min Wasted Ventilation (RR = 12) = 170 ml x 12 = 2.04 L/min</p> Signup and view all the answers

Match the correct interpretations for low and high lung compliances:

<p>Low Compliance = Stiff lung, making lung expansion difficult. High Compliance = Pliable lung, leading to incomplete exhalation and CO2 elimination. Fibrosis = Example of condition associated with low compliance. Emphysema = Example of condition associated with high compliance.</p> Signup and view all the answers

Match the clinical scenario with the most likely change in airway resistance:

<p>Patient with worsening asthma = Increased airway resistance due to bronchoconstriction Intubated patient with mucus plug = Increased airway resistance due to mechanical obstruction Patient with emphysema = Increased airway resistance due to airway collapse Patient post-bronchodilator = Decreased airway resistance due to airway smooth muscle relaxation</p> Signup and view all the answers

Match the term with their meaning related to alveolar ventilation:

<p>Alveolar Ventilation (Va) = The volume of fresh gas that reaches the alveoli for gas exchange. Minute Ventilation (Ve) = The total volume of gas entering or leaving the lungs per minute. Dead Space Ventilation = The volume of gas that does not participate in gas exchange. Efficiency of Ventilation = Dependent on the volume of fresh gas reaching the alveoli (Va).</p> Signup and view all the answers

Match the clinical condition with the type of dead space it primarily affects:

<p>Pulmonary embolism = Increases alveolar dead space by obstructing blood flow to ventilated alveoli. Tracheostomy = Typically reduces anatomical dead space by shortening the conducting airways. Normal Ventilation = Includes anatomical dead space, which is a normal component. Positive Pressure Ventilation = Can alter both anatomical and alveolar dead space due to changes in airway pressures and gas distribution.</p> Signup and view all the answers

Match each term related to the pressure-volume loop with its clinical implication:

<p>Upper Inflection Point = May indicate alveolar overdistension, requiring adjustments to tidal volume or PEEP. Lower Inflection Point = May indicate alveolar collapse, requiring higher PEEP levels. Increased Area of Loop = Represents an increase in the work of breathing. Shift of Loop to the Right = Indicates decreased lung compliance, such as in ARDS.</p> Signup and view all the answers

Match the method to measure static and dynamic compliance:

<p>Obtain corrected expired tidal volume = Subtract Tubing Volume Obtain plateau pressure = Apply inspiratory hold Obtain peak inspiratory pressure = Measured during inspiration Obtain PEEP = The positive end-expiratory pressure</p> Signup and view all the answers

Match the following types of compliance and measurements to measure the compliance.

<p>Static Compliance = Corrected Tidal Volume / (Plateau Pressure PEEP) Dynamic Compliance = Corrected Tidal Volume / (Peak Inspiratory Pressure - PEEP) Low Compliance = Indicates a stiff lung (one with high elastic recoil) High Compliance = Indicates a pliable lung (one with low elastic recoil)</p> Signup and view all the answers

Match the type of assessment to the appropriate lung function

<p>Static Compliance = Measured when there is no air flow Dynamic Compliance = Measured when air flow is present Low Resistance = Air flow moves easily High Resistance = Air flow needs more pressure to move</p> Signup and view all the answers

Match the following scenarios with the corresponding changes in PIP and Plateau pressures:

<p>Increased Airway Resistance = Increased PIP, unchanged Plateau Decreased Lung Compliance = Increased PIP, Increased Plateau Decreased Airway Resistance = Decreased PIP, unchanged Plateau Increased Lung Compliance = Decreased PIP, Decreased Plateau</p> Signup and view all the answers

Match the terms with the formula.

<p>$Raw$ = $(PIP - Plateau) / Vi$ $Static Compliance$ = $Vt / (Plateau - PEEP)$ $Dynamic Compliance$ = $Vt / (PIP - PEEP)$ Alveolar Ventilation ($Va$) = $Vt - Vds$</p> Signup and view all the answers

Match the given data to the Alveolar Ventilation amount. Vt is 300ml and the RR is 28, Assume fixed dead space

<p>Alveolar ventiation equation = $Va = V_t - V_{ds}$ Minute Ventilation (Ve) = 8.40 l/m Dead Space = 150 mL Va = 4.2 l/m</p> Signup and view all the answers

Match the following calculation to the waste amount of inspired breath and total.

<p>Ventilation without perfusion = Waste ventilation VD / VT = Normal .2 to .4 VD / VT &gt; .6 = For some patients Ventilation space without gas exchage = Dead space</p> Signup and view all the answers

Match each of the equations to the answer. Please assume that these numbers are correct. $V_t$ is 450, where $PA_{CO_2}$ is 44 an PeCO2 is 22

<p>$P_aCO_2 - P_eCO_2$ = 22 $\dfrac{P_aCO_2}{P_aCO_2 - P_eCO_2}$ = .5 $\dfrac{ P_aCO_2 - P_eCO_2}{P_aCO_2} * 100$ = 50% Wasted 450mL - Wasted = 225mL Left</p> Signup and view all the answers

Match each of the lung terms with the following definition.

<p>Pressure = Measure of the force exerted on the airways and alveoli. Resistance = A measure of the impediment to airflow in the airways. Compliance = How well the lungs are expanding. Volume = Is how much exchange is inspired or expired.</p> Signup and view all the answers

Match each of the following situations to the amount of pressure that is required to move the inspiration.

<p>Resistance during inspiration = Pressure increases Resistance increase = Pressure Increases Static measure = No Flow Dynamic measure = Consistent flow</p> Signup and view all the answers

Match the corresponding auto-PEEP with with normal PEEP.

<p>Auto-PEEP = Is a level of PEEP where more pressure is added on top of the usual PEEP Flow when Auto-PEEP is occoring = Does not reach a zero or baseline level before the second inspiration is started PEEP has been corrected = The flow will reach closer to a zero or baseline level Both PEEPs = Cause an increase and improve oxygentation.</p> Signup and view all the answers

Flashcards

Airway Resistance

Obstruction of airflow in the airways.

Factors Affecting Airway Resistance

Length, size, and patency of the airway, endotracheal tube, and ventilator circuit.

Frictional Resistance

Impedance related to the movement of gas through the airways

Airway Resistance Percentage

Accounts for approximately 80% of the frictional resistance to ventilation.

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COPD-Related Airway Resistance

Emphysema, chronic bronchitis, asthma, bronchiectasis.

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Mechanical causes of airway resistance

Post-intubation obstruction, foreign body aspiration, endotracheal tube issues, condensation.

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Infection Related Airway Resistance

Laryngotracheobronchitis (croup), epiglottitis, bronchiolitis.

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Airway Caliber Resistance Rule

Sixteen-fold change in resistance.

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Normal Raw

0.5 to 2.5 cmH2O/L/sec.

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Airway Resistance Calculation

PIP is 26 and Plateau (Plt) 20 with 37 L/m = 9.8 cmH2O/L/sec

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Lung Compliance

Volume change per unit pressure change during breathing.

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Clinical practice for lung compliance

Separating compliance into static and dynamic compliance.

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Static Lung Compliance

Change in volume for any given applied pressure.

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Dynamic Lung Compliance

Compliance of the lung at any given time during actual movement of air.

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Low Lung Compliance

Stiff lung (high elastic recoil), thick balloon e.g. fibrosis.

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High Lung Compliance

Pliable lung (low elastic recoil) grocery bag, e.g. emphysema.

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Abnormal Lung Compliance Consequence

Lung issues can cause ineffective gas exchange.

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Conditions of Low Compliance

Atelectasis, ARDS, tension pneumothorax, obesity, retained secretions.

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Dynamic Compliance Decrease

Bronchospasm, kinking of ET tube, airway obstruction.

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Compliance Assessment

Dividing compliance into static and dynamic measurements.

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Measure Static Compliance

Measured when there is no air flow (Plateau Pressure - PEEP).

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Static Compliance Reflected

Elastic resistance of the lung and chest wall.

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Measuring Dynamic Compliance

Measured when air flow is present (using the Peak Airway Pressure-PEEP).

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Dynamic Compliance Reflected

Condition of airway resistance (non-elastic resistance) and elastic properties.

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Inflection Point

Where the lungs over come the initial pressure to fill the lung.

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Deflection Point

Occurs when the lungs stop expanding but pressure is increased as the gas continues to be pushed in.

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Minute Ventilation Dependence

Minute ventilation depends on the size of the subject and his or her metabolic rate.

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Ve

Minute ventilation depends on the size of the subject and his or her metabolic rate. Ve values range from 5 to 10 L/min in healthy adults.

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Dead Space Ventilation assessment

Estimation of wasted ventilation is key in assessing the efficiency of ventilation.

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Dead space components

Anatomical and alveolar dead space

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Anatomical Dead Space

The volume of the conducting airways and averages about 1 ml per pound of Ideal Body Weight.

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Alveolar Dead Space

Some alveoli may not participate in gas exchange, example: a pulmonary embolism

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Pulmonary Circulation Example

Pulmonary embolus

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What effect does pulmonary embolus have?

Blocks a portion of the pulmonary circulation.

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Alveolar Ventilation (Va)

The efficiency of ventilation depends on the volume of fresh gas reaching the alveoli (Va).

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The spontaneous VT of 425ml and the RR is 18 what is the VE?

425 x 18 = 7.65 l/m.

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The spontaneous VT of 425ml and the RR is 18 what is the VA?

425 - 140 DS = 285 ml x 18 = 5.13 Va

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The spontaneous VT of 425ml and the RR is 18 what is the VE?

2.52 l/m is wasted ventilation.

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The spontaneous VT of 425ml and the RR is 18 what is the VA?

Va= 5.13 l/m is effective ventilation (Va).

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Alveolar Ventilation Calculation

300 x 28 = 8.40 l/m

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Vt of 300ml and RR of 28, what is wasted ventilation?

300 – 150 DS = 150 ml x 28 = 4.2 l/m Va.

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Alveolar Ventilation Calculation (Va

4.2 l/m is wasted Ve

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Physiological Dead Space

The sum of anatomical and alveolar dead space.

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normal VD/VT

20 to 40%

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amount wasted

physiological dead space

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Ventilation Failure Etiology

When a patient's ventilatory or oxygenation process fails, it might stem from six key factors.

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High Compliance Problems

High compliance leads to insufficient exhalation and CO2 buildup.

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Pulmonary Embolism

An example is a pulmonary embolism.

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Anatomical Dead Space Volume

Averages about 1 ml per pound of Ideal Body Weight

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Calculating Non-Effective VT

Dead space percentage times the delivered VT equals the size of noneffective VT.

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Vt is 425ml/Vt and 130lbs IBW is how much alveolar Ventilation

Alveolar Ventilation= 295ml/Vt (this is what is getting to the alveoli for exchange)

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Dead space subdivision

Dead space can be subdivided into the following two components: anatomical dead space and alveolar dead space.

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Study Notes

Changes in Ventilator Measurements

  • Reviewing ventilator changes such as PIP (Peak Inspiratory Pressure) and PLT (Plateau Pressure) can provide valuable insights into a patient's respiratory status and the effectiveness of mechanical ventilation
  • Closely monitoring ventilator data helps clinicians assess trends and make informed decisions to optimize patient care

Auto-PEEP

  • Auto-PEEP is an unintended build-up of positive end-expiratory pressure in the lungs, resulting from incomplete exhalation before the next breath

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