Physics exam 1 , ch.43

Ch. 43

IPPB

Intermettient positive pressure breathing

IS

Incentive spirometry

CPAP

Continuous positive airway pressure

PEP

Positive expiratory pressure

Passive atelectasis

“You don’t use it, you lose it”, persistent small tidal volumes caused by general anesthesia, sedatives, bed rest and painful deep breathing

Lobar atelectasis

5% of patients undergoing lung resection will develop atelectasis in one lobe caused by large mucus plugs, found in patients with restrictive chest wall abnormalities, obese, heavy sedatives, bed rest, poor cough, surgery near diaphragm

What makes a high risk for atelectasis?

Surgery near the diaphragm which reduces lung volumes

what makes a postoperative patient more vulnerable for atelectasis?

Smoking history, upper abdominal surgery, abnormal preoperative spirometry, lung disease that cause excess mucus ( COPD, bronchia stasis, cystic fibrosis)

Minimal signs of atelectasis

Subtle, mild dyspnea, low fever, slightly diminished breath sounds

Significant signs of atelectasis

Tachypnea, late inspiratory crackles, diminished breath sounds blocked by secretions, tachycardia, hypoxemia

How to confirm atelectasis

Chest X-ray with increased white and evidence of volume loss, elevation of the diaphragm and narrowed space in between the ribs

Lung expansion physiology

To expand the lung volume, the trans pulmonary pressure gradient must be increased, this makes the alveoli more expanded

What causes increase of transpulmonary pressure

Deep inspiration, positive pressure,

What are the goals of lung expansion therapy

Prevent/ treat atelectasis, open up alveoli, improve gas exchange, mobilize secretions for airway clearance, strengthen respiratory muscles

What device would a high risk of atelectasis patient after a upper abdominal surgery use?

IS , Incentive Spirometry device

What device would a high risk patient use if they are unable to perform the Incentive Spirometry due to not being able to take a deep breath?

Positive pressure therapy with the PEP device

What device is this?

Incentive Spirometry device, a lung expansion device with visual cues when the desired inspiratory flow is reached and is highly effective for preventing atelectasis

Indications for incentive spirometry device IS

Presence of pulmonary atelectasis, upper abdominal surgery, thoracic surgery, COPD post operative patients, restrictive lung defect like scoliosis

Contradictions for incentive spirometry device IS

If the patient can’t be instructed on how to perform, the patient is uncooperative, patient can’t take a deep breath ( VC < 10 mL/kg)

Hazards associated with Incentive Spirometry IS device

Hyperventilate + respiratory alkalosis, discomfort, pulmonary barotrauma, bronchospasm, fatigue

Incentive spirometry device description

Small, portable, cheap, flow or volume orientated

What is IPPB

Intermittent Positive pressure breathing device that uses positive pressure to expand the lungs, treatment typically last 15 to 20 minutes and uses a bag to measure how many breaths it takes to fill the lungs.

What device is this?

IPPB , intermittent positive pressure breathing

Indications for IPPB, intermittent positive pressure breathing

Patient with atelectasis that is improving from incentive spirometry or can’t perform IS

Contraindications for IPPB, intermittent positive pressure breathing

Tension pneumothorax, intracranial pressure above 15, hemodynamic instability , TB, esophageal surgery , bleb, facial surgery, hiccups, nausea

Hazards associated with IPPB, intermittent positive pressure breathing

increased airway resistance, barotrauma, nosocomial infection from the device not being single use, respiratory acidosis/ alkalosis , air trapping

What is pulmonary barotrauma?

Lung tissue damage due to high pressures and high volumes common with emphysema

What is hypocapnia and how does it relate to respiratory alkalosis?

Low levels of CO2 in the blood, ( PaCO2 is below 35) meaning that the blood looses acidity making the blood alkalotic.

Signs of hypocapnia/ respiatory alkalososi?

Numbness, tingling of extremities

What is hyperoxia?

A condition of excess oxygen causing dizziness, confusion and potential lung damage, causes are scuba diving

What is gastric distension?

Positive pressure applied to the pharynx that causes the esophagus to open allowing the stomach to be pumped full of oxygen instead of the trachea that leads to the lungs

What is air trapping and auto PEEP?

When the pressure remaining in the alveoli at end inspiration is over 0 , air trapping causes lung over distenstion that increased the work of breathing along with pulmonary vascular resistance

How to avoid air trapping?

Allow proper time for exhaling at flow rates of 6 L to 8 L per minute with expiratory times of 4 to 5 seconds

Positive outcomes of IPPB, intermittent positive pressure breathing

Improved inspiratory, improved vital capacity, better cough and secretion movement, improved chest x ray

IPPB, intermittent positive pressure breathing application and parameters

Sit the patient up, tight seal around the mouthpiece, sensitivty set at -1 or -2, pressure set to 10 to 15 cm H2O

Triple - S rule

Stop: the treatment

Stay: with the patient

Stabilize: the patient

What is CPAP ?

Continuous positive airway pressure, a device that ranges from 5 cm to 20 cm H2O that delivers continuous positive and negative pressure that can be used at home, hospital, and the ICU. Intended to keep the airways open, decrease work of breathing and mobilize secretions.

Gas absorption atelectasis

Complete interruption of ventilation to a section of the lung where there is a shift in the ventilation/ perfusion ratio

Compression atelectasis

When the transthoracic pressure exceeds the transalveolar pressure

What device is this?

Positive expiratory pressure device, PEP

What device is this?

CPAP, continuous positive airway pressure

Hypocapnia

Primary cause Respiratory alkalosis

Hypercapnia

Primary cause of respiratory acidosis

CPAP risk

hypoventilation, resp alk