Respiration and Ventilation: Key Concepts

• Respiration is the exchange of oxygen and carbon dioxide at the alveolar and cellular levels.
• Ventilation is the movement of air into and out of the lungs.
• The upper airway includes the nose, mouth, pharynx, larynx, and epiglottis.
• The lower airway includes the trachea, bronchi, bronchioles, and alveoli.
• The diaphragm and intercostal muscles are the primary muscles involved in breathing.
• Normal adult respiratory rate is typically 12-20 breaths per minute.
• Adequate breathing characteristics include a regular pattern of inhalation and exhalation, clear and equal lung sounds bilaterally, and adequate tidal volume.
• Inadequate breathing signs include abnormal respiratory rate, irregular breathing pattern, diminished or absent lung sounds, and use of accessory muscles.
• Hypoxia is a condition in which the body's tissues and cells do not receive enough oxygen.
• Signs and symptoms of hypoxia include altered mental status, cyanosis, and shortness of breath.
• Oxygen administration is indicated for patients with hypoxia or suspected hypoxia.
• Oxygen can be delivered via nasal cannula, non-rebreathing mask, or bag-valve mask.
• A nasal cannula delivers low-flow oxygen, typically 1-6 liters per minute (LPM), providing an oxygen concentration of 24-44%.
• A non-rebreathing mask delivers high-flow oxygen, typically 10-15 LPM, providing an oxygen concentration of up to 90%.
• A bag-valve mask (BVM) is used for artificial ventilation, delivering supplemental oxygen concentrations of up to 100%.
• Artificial ventilation is the process of manually inflating the lungs when a patient is unable to breathe adequately on their own.
• Indications for artificial ventilation include apnea, inadequate respiratory rate, and inadequate tidal volume.
• Methods of artificial ventilation include mouth-to-mouth ventilation, mouth-to-mask ventilation, and bag-valve mask ventilation.
• A bag-valve mask (BVM) consists of a self-inflating bag, one-way valve, mask, and oxygen reservoir.
• When using a BVM, ensure a tight mask seal over the patient's mouth and nose to prevent air leakage.
• Deliver slow, gentle breaths over 1 second to avoid gastric distension.
• The recommended ventilation rate for adults is 10-12 breaths per minute.
• For infants and children, the recommended ventilation rate is 12-20 breaths per minute.
• Gastric distension can occur during artificial ventilation, especially if breaths are delivered too forcefully or rapidly.
• Signs of gastric distension include abdominal swelling and regurgitation.
• A stoma is a surgical opening in the neck that connects the trachea to the skin.
• Patients with a stoma may require artificial ventilation through the stoma.
• Use a pediatric-sized mask or a BVM directly over the stoma to provide ventilation.
• Suctioning is the process of removing fluids or foreign materials from the airway.
• Indications for suctioning include visible secretions, gurgling respirations, and suspected airway obstruction.
• Use a rigid or flexible catheter to suction the airway.
• Limit suctioning to 15 seconds at a time in adults, and 10 seconds in children and infants.
• A pulse oximeter measures the percentage of hemoglobin in the blood that is saturated with oxygen (SpO2).
• Normal SpO2 values are typically between 95% and 100%.
• Factors that can affect pulse oximetry readings include poor perfusion, hypothermia, nail polish, and carbon monoxide poisoning.
• Capnography measures the concentration of carbon dioxide (CO2) in exhaled breath.
• Capnography can be used to assess the effectiveness of ventilation and monitor for changes in respiratory status.
• Normal end-tidal CO2 (EtCO2) values are typically between 35-45 mmHg.
• Airway obstruction can be caused by foreign bodies, tongue obstruction, or swelling.
• Signs of airway obstruction include choking, stridor, and inability to speak.
• The head-tilt/chin-lift maneuver is used to open the airway in patients without suspected spinal injury.
• The jaw-thrust maneuver is used to open the airway in patients with suspected spinal injury.
• Oropharyngeal airways (OPAs) and nasopharyngeal airways (NPAs) are used to maintain an open airway in unconscious patients.
• An OPA is inserted into the mouth to prevent the tongue from obstructing the airway.
• An NPA is inserted into the nose to prevent the tongue from obstructing the airway.
• Continuous Positive Airway Pressure (CPAP) is a form of non-invasive ventilation that provides constant pressure to keep the airways open.
• CPAP is used to treat conditions such as pulmonary edema and COPD exacerbation
• Wheezing indicates constriction or inflammation in the bronchioles
• Crackles (rales) often indicate fluid in the alveoli
• Stridor indicates upper airway obstruction
• Absent lung sounds suggest significant airway or breathing compromise on that side
• Positioning is very important
• Recovery position should be used if no suspected trauma
• Patients with chest pain or difficulty breathing can be placed in a position of comfort, often sitting upright
• Remember that pediatric airways differ anatomically
• The tongue is larger in proportion to the mouth
• The trachea is narrower and more flexible
• They rely more on their diaphragm for breathing

Understand the basics of respiration and ventilation, including the upper and lower airways. Learn about the muscles involved in breathing, normal respiratory rates, and signs of adequate vs. inadequate breathing. Recognize the causes, signs, and symptoms of hypoxia.