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Perf Tech 3 > 3. Pulmonary Response- Exam 1 > Flashcards

3. Pulmonary Response- Exam 1 Flashcards

1
Q

define Atelectasis

A

A complete or partial collapse of a lung or a lobe of the lung - develops when the alveoli become deflated and don’t inflate properly

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2
Q

Atelectasis is the most common pulmonary complication by what %

A

70%

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3
Q

what are the 2 variables of degree of Atelectasis that remains when lungs are re-expanded and ventilated

A

microscopic

lobar

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4
Q

ATELECTASIS decreases functional residual capacity by ___% after general anesthesia

A

20%

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5
Q

ATELECTASIS decreases functional residual capacity ___% after CPB

A

40-50%

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6
Q

ATELECTASIS impares oxygenation by what 4 things

A

decreased functional residual capacity
decreased lung compliance
increased veno-arterial admixture
Alveolar-arterial oxygen gradient –P(A-a)O2 increases

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7
Q

what 3 risk-factors contribute to pre-op atelectasis

A

smoking, chronic bronchitis
obesity
cardiogenic pulmonary edema

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8
Q

what 3 risk-factors contribute to intra-op atelectasis

A

anesthesia: reduced surfactant function
passive ventilation
monotonous ventilator pattern

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9
Q

what 5 risk-factors contribute to CPB atelectasis

A 
surfactant inhibition
plasma, lung distention, lung ischemia
increased extravascular lung water
heart rests on immobile left lower lobe
open pleural cavity – accumulation of blood and fluid
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10
Q

WHAT CAN WE DO TO PREVENT ATELECTASIS?

A

Decrease complement activation
Reduce chances of edema
Anesthesia has more control (PEEP, CPAP, OLC)

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11
Q

describe 1950’s “Pump Lung”: acute respiratory failure (5)

A 
lungs diffusely congested
intra-alveolar and interstitial edema
hemorrhagic atelectasis
vessel lumina full of neutrophils
diffuse swelling of endothelial cells
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12
Q

WHAT 5 things MIGHT CAUSE ACUTE LUNG INJURY?

A 
Embolic load
Membrane damage from immune response
Decreased pulmonary blood flow
Hemodilution
Elevated pulmonary artery pressure
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13
Q

Emboli can lead to areas of ventilation/perfusion mismatching. What 5 things can cause this?

A 
aggregated proteins
disintegrated platelets
damaged neutrophils
fibrin
fat globules
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14
Q

Introduction of what greatly reduced degenerative lesions in lung

A

arterial and cardiotomy filters

Better the filtration – more normal the lungs

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15
Q

Complement Activation is Found wherever blood meets foreign surface. Give 2 examples

A

hemodialysis

leukophoresis

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16
Q

Complement Activation Provides several functions for fighting invading organisms. Give 3 examples

A
  • leukocyte activation
  • cytolysis
  • opsonization (makes bacterial cells vulnerable to phagocytosis by attaching various items)
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17
Q

what 4 things can cause membrane damage in acute lung failure

A

Complement Activation
Vasoactive compounds from PMNs
Oxygen free radicals
Ischemia reperfusion injury

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18
Q

Even though the Lungs are isolated from pulmonary circulation during bypass, Lung tissue still has metabolic activity. What is it at 36C and 28C

A

11 mL/minute at 36 oC

5 to 6 mL/minute at 28 oC

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19
Q

Is Bronchial circulation still functional during CPB

A

yes

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20
Q

why is hemodilution a concern

A

Concerned with decrease in colloid osmotic pressure and movement of fluid into the intracellular space

21
Q

Studies seem to indicate the accumulation of pulmonary extravascular water is not affected by what?

A

the type of priming solution

22
Q

Hemodilution does not appear to harm the lungs, it actually prevents impairment of what?

A

surfactant

23
Q

Potential cause of pulmonary edema due to what 2 things

A

Inadequate venting

Increased bronchial blood flow

24
Q

what can cause ELEVATED PA PRESSURE

A

pulmonary edema

complement activation

25
Q

how often does ACUTE BRONCHOSPASM DURING BYPASS occur

A

rare

26
Q

ACUTE BRONCHOSPASM DURING BYPASS can be triggered by what (8)

A
  1. activation C5a (fulminant bronchospasm)
  2. cold urticaria syndrome (release histamine when exposed to cold)
  3. preexisting bronchospastic disease
  4. instrumentation
  5. secretions
  6. cold anesthetic gas in patients with hyperactive airways
  7. allergic reactions to antibiotics or protamine
  8. drugs that induce histamine release
27
Q

how do you manage bronchospasm during bypass

A

Stay on bypass or reinitiate bypass

Rest up to anesthesia

28
Q

management bronchospasm: administration of beta selective agonists directly into endotracheal tube. Give 2 examples

A

albuterol, metaproterenol

29
Q

management bronchospasm: small IV boluses of _____ followed by continuous low-dose infusion

A

epinephrine

30
Q

management bronchospasm: why is IV lidocaine given

A

to decrease airway hyperactivity

31
Q

management bronchospasm: volatile anesthetic agents can be given through pump. Give 2 examples

A
  1. potent bronchodilators

2. halothane sensitizes myocardium to catecholamines – risk of tachyarrhythmias

32
Q

name 9 things you can do for PREVENTION & TREATMENT OF ACUTE LUNG INJURY

A
  1. Blood filtration
  2. Coated circuits
  3. Membrane oxygenators
  4. Hemodilution- avoid homologous blood primes
  5. Proper LV venting
  6. Steroids
  7. Prostaglandins
  8. Aprotinin
  9. Inhaled Nitric Oxide
33
Q

steroids do not effect what

A

does not affect C3a activation or leukocyte elastase release

34
Q

steroids may inhibit what

A

may inhibit increase in leukotriene B4 and tissue plasminogen activator

35
Q

what other problems can steroids cause

A

increased blood loss

low cardiac output syndrome

36
Q

give 2 examples of what you would use for blood filtration

A

leukocyte depletion, removal of endothelin-1

37
Q

Prostaglandins may be more protective than what?

A

corticosteroids

38
Q

Prostaglandins inhibit what?

A

intravascular pulmonary leukocyte aggregation, activation, and free radical production

39
Q

Prostaglandins need to be careful because of?

A

hypotensive effect

40
Q

Aprotinin inhibits what?

A

serine proteases (plasmin & kallikrein)

41
Q

Aprotinin prevents what?

A

the activation of kininogen and formation of bradykinin

42
Q

Aprotinin definitely reduces blood usage by doing what?

A

preventing platelet aggregation and inhibiting fibrinolysis

43
Q

Aprotinin attenuates what?

A

bradykinin-induced increases in vascular permeability

44
Q

Aprotinin reduces what?

A

lung neutrophil accumulation after bypass

45
Q

Inhaled Nitric Oxide- Endogenous production is reduced post CPB… this Potentiates what?

A

pulmonary hypertension

46
Q

Inhaled Nitric Oxide Provides what?

A

potent vasodilation in the pulmonary vasculature

47
Q

Inhaled Nitric Oxide Used to treat what?

A

elevated pulmonary vascular resistance

48
Q

Inhaled Nitric Oxide has Some anti-inflammatory properties such as

A

Decreases IL-8
Attenuates neutrophil adhesion and migration
Attenuates apoptosis in lungs

Perf Tech 3 (15 decks)

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