alveolar ventilation during general endotracheal anesthesia valentyna groelle, rn, bsn, srna
TRANSCRIPT
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Alveolar Ventilation During General Endotracheal
Anesthesia
Valentyna Groelle, RN, BSN, SRNA
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1. Review the physiology of alveolar ventilation
2. Discuss pulmonary changes after induction of general endotracheal anesthesia
3. Describe how to perform two major types of alveolar recruitment maneuvers
Objectives
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Conducting vs Gas Exchange Airways
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Alveolar-Capillary Gas Exchange
L
CDA
t
Q
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Physiology of Gas Exchange
Internal Respiration
External Respiration
Ventilation
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West’s Zones of the Lung
“Dead space”
“Shunt-like”
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Alveolar Ventilation
Alveolar Ventilation VA= RR x (VT-VD)
Physiologic Dead Space VD/VT = (PaCO2−PECO2)/PaCO2
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Alveolar Gas Exchange in Lung Disease
L
CDA
t
Q
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ARDS
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Asthma
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COPD and Air Trapping
NORMAL COPD
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Atelectasis
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A-a Gradient
A-a Gradient= PAO2-PaO2 PAo2=FiO2(Patm-PH2O)-
PaCO2/0.8
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Causes of Hypoxemia
Normal A-a gradient
1. Hypoventilation2. Low Inspired O2
Increased A-a gradient
1. Right to Left Shunt 2. V/Q Mismatch 3. Diffusion Impairment
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Causes of HypoxemiaNormal A-a gradient
Hypoventilation
a. Neuromuscular disorder
b. CNS disorderc. Depression of CNS
by drugs
Low Inspired OxygenPiO2=(Patm-PH2O)xFiO2a. High altitudeb. Low FiO2
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Causes of HypoxemiaIncreased A-a gradient
Right to Left Shunt(alveoli blocked from ventilation) a. CHFb. ARDSc. Drowning(due to congenital abnormalities)d. Intra-cardiac shunte. Intra-pulmonary fistulas
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Causes of HypoxemiaIncreased A-a gradient
V/Q Mismatch (due to lung dead space or shunt)a. PEb. Atelectasisc. PNAd. Obstructive lung
disease (asthma, COPD)
e. Pneumothorax
“Shunt-like” “Dead-space”
VA= 4-6 L/minQ=5-6 L/minV/Q= 0.8-1.2
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Causes of HypoxemiaIncreased A-a gradient
Diffusion impairment
a. Interstitial lung disease
b. Environmental disease
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Induction of General Anesthesia
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Cessation of Sigh Breaths
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Absorption Atelectasis
Solubility of gases in blood plasma:Carbon dioxide>oxygen>nitrogen
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Airway Closure from ↓ FRC
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Compressive Atelectasis
Transpulmonary P =Intrapulmonary/Alveolar P-Intrapleural PTranspulmonary P= 760mmHg-756mmHg= +4mmHg
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Open Lung Ventilation
Alveolar Recruitment Maneuvers
Low Tidal Volumes
PEEP
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Alveolar Recruitment Maneuvers
1. The lung’s opening
pressure
2. The lung’s closing
pressure
3. The open-lung PEEP
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Sustained Inflation Recruitment Maneuvers
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Cycling Maneuvers
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Hemodynamic Pre-Conditioning Phase
PEEP of 5 cmH2O= 3.67 mmHgPEEP of 10cmH2O= 7.35 mmHgPEEP of 13cmH2O= 9.55mmHg
Normal CVP: 0-8 mmHgNormal PAP (systolic): 15-25 mmHgNormal PAP (diastolic): 8-15mmHg
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Cycling Maneuvers
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SI vs Cycling Recruitment Maneuvers
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Questions