Obstructive Lung Disease Flashcards
(169 cards)
1
Q
- Obstructive respiratory diseases can be divided into 4 groups regarding their influence on anesthetic management:
A
- Acute upper respiratory tract infection (URI)
- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Miscellaneous respiratory disorders
2
Q
- Ages 25-44 experience the “common cold” at a rate of ____% per year
A
19
3
Q
- Ages 45-65 experience it at a rate of ____% per year
A
16
4
Q
________________ accounts for ̴95% of all URIs
A
Infectious Nasopharyngitis
5
Q
What are the Most common associated viral pathogens?
A
rhinovirus,
coronavirus,
influenza,
parainfluenza,
and respiratory syncytial virus (RSV)
6
Q
- Noninfectious nasopharyngitis can be __________ or ____________ in its origin
A
allergic ; vasomotor
* Diagnosis is usually based on clinical symptoms
7
Q
T/F: Viral cultures & lab tests lack sensitivity, and are time consuming & expensive
* impractical in a busy clinical setting
A
T
8
Q
___________ with URI’s have a higher risk of perioperative respiratory adverse events s/a transient hypoxemia, laryngospasm, breath holding, and coughing
A
- Children
- Data on adults with URI’s undergoing anesthesia is limited
9
Q
Can A pt who has had a URI for weeks and is stable or improving be safely managed without postponing surgery?
A
Yes
10
Q
If surgery is cancelled d/t acute URI, it should not be rescheduled within __________ as studies indicate that airway hyperreactivity may persist for that duration
A
6 weeks
11
Q
____________ scoring system is used to determine risk of proceeding with surgery
A
The COLDS
12
Q
COLDS takes into account:
A
current sx’s,
onset of sx’s (higher risk within 2 weeks),
presence of lung disease,
airway device (ETT= higher),
and surgery (major airway surgery = higher risk)
13
Q
Anesthetic management of pts w/URI’s should include: __________, __________, and ____________
A
adequate hydration, reducing secretions, and limiting airway manipulation
14
Q
Use of an ______, rather than an________, may reduce the risk of laryngospasm
A
LMA
ETT
15
Q
Considerations for induction and maintenance are similar to those with __________
A
Asthma
16
Q
When there are no contraindications, ______________may allow for a smoother emergence
A
deep extubation
17
Q
Adverse respiratory events in pts with URIs include:
A
bronchospasm,
laryngospasm,
airway obstruction,
postintubation croup,
desaturation,
and atelectasis
- Intraoperative and postoperative hypoxemia are common (fix by giving more O2)
18
Q
Asthma leads to Activation of the inflammatory cascade leads to infiltration of the airway mucosa with _________, _________, __________, _________, ___________ and ___________
A
eosinophils, neutrophils, mast cells, T cells, B cells, and leukotrienes
- This results in airway edema, especially in the bronchi
19
Q
Airway remodeling leads to thickening of the ___________ and ___________
A
basement membrane and smooth muscle mass
20
Q
- The main inflammatory mediators implicated in asthma include __________, ___________ and ___________
A
histamine, prostaglandin D2, and leukotrienes
21
Q
- Asthma provoking stimulators:
A
22
Q
Asthma is an episodic disease with __________ and ____________
A
acute exacerbations and asymptomatic periods
23
Q
Sx’s include expiratory wheezing, productive or nonproductive cough, dyspnea, chest tightness that may lead to air hunger, and ______________
A
eosinophilia.
- Most attacks are short-lived, lasting minutes to hours
24
Q
What is Status asthmaticus:
A
dangerous, life-threatening bronchospasm that persists despite treatment
25
When the history is obtained from an asthma pt, attention should focus on ____________, ____________, ___________ and ______________
previous intubations,
ICU admission,
2+ hospitalizations for asthma in the past year,
and the presence of coexisting diseases
26
Asthma is diagnosed when a pt reports wheezing, chest tightness, or SOB and demonstrates airflow obstruction on PFT that is at least partially reversible with __________
bronchodilators.
27
* Classification of asthma severity d/o the _________, ___________, and ____________-
symptoms, PFTs, and medication usage
28
FEV1 normal range
80-120% of the predicted value
29
FVC normal for males and females
Females: 3.7L
Males: 4.8L
30
Ratio of FEV1 to FVC in healthy adults:
75-80%
31
FEF should be:
25-75% of VC.
A measurement of airflow through the midpoint of a forced exhalation
32
Maximum Voluntary ventilation MVV.
Maximum amount of air that can be inhaled and exhaled within 1 minute.
For comfort: measured over 15 seconds.
33
MVV value for males and females
Males: 140-180 L/Min
Females: 80-120 L/Min
34
Diffusing capacity of lungs (DLCO)
The volume of a substance (CO) transferred accross the alveoli into the blood per minute of alveolar partial pressure.
35
DLCO normal value:
Transfer is diffusion limited:
A single breath of 0.3% CO and 10% Helium is held for 20sec.
Expired partial pressure of CO is measured...
Normal value is 17-25mL/min/mmHg
36
* Forced expiratory volume in 1 second (FEV1), forced expiratory flow (FEF), and midexpiratory phase flow are direct measures of the ___________ of expiratory obstruction
severity
* The typical symptomatic asthmatic pt who comes to the hospital has an FEV1 <35%
37
During moderate or severe asthma attacks, the _________________ may increase substantially, but _______________ usually remains normal.
WHat is not changed?
functional residual capacity (FRC)
total lung capacity (TLC)
* Diffusing lung capacity for carbon monoxide is not changed
38
Abnormalities in PFTs may persist for several days after an attack despite the absence of symptoms
Interesting!
39
T/F: Since asthma is an episodic illness, its diagnosis may be suspected even w/ normal PFT results
T
40
* Mild asthma is usually accompanied by a normal _______ and _________
Pa02 and PaC02
41
During an attack, tachypnea and hyperventilation is caused by ____________ of the lungs, not __________
neural reflexes
hypoxemia
42
_____________and _____________ are the most common ABG findings of symptomatic asthma
Hypocarbia
respiratory alkalosis
43
* As the severity of expiratory obstruction increases, the associated ventilation/perfusion mismatching may result in a Pa02 of <____ mmHg
60
44
* The PaC02 is likely to increase when the FEV1 is <___% of predicted
25
* Fatigue of the skeletal muscles necessary for breathing may contribute to the development of hypercarbia
45
* Pts w/severe asthma may demonstrate _________ and _____________ due to mucous plugging and pulmonary HTN
hyperinflation
hilar vascular congestion
* CXR’s can be helpful in determining the cause of an asthma exacerbation and ruling out other causes
46
_________may show signs of RV strain or ventricular irritability during an asthma attack
* EKG
47
_________________ is 1st line tx in pts with mild asthma
* A short-acting inhaled β2 agonist
This is only recommended in those w/ < 2 exacerbations/month
48
* Following short-acting β2 agonist, _________ improve sx’s, reduce exacerbations and decrease risk of hospitalization
daily inhaled corticosteroids
49
* Other therapies:
Inhaled muscarinic antagonists,
leukotriene modifiers,
and mast cell stabilizers
* Systemic corticosteroids are reserved for severe asthma, uncontrolled with inhalational medications
50
Studies show that ___________ decreases use of long-term medications and may improve quality of life
SQ immunotherapy
* Systemic corticosteroids are reserved for severe asthma, uncontrolled with inhalational medications
51
____________ is recently approved and the only nonpharmacologic tx for refractory asthma
* Bronchial thermoplasty (BT)
52
* BT uses __________ to deliver radiofrequency ablation of airway smooth muscles to all lung fields except the right middle lobe
bronchoscopy
* The procedure is performed in three sessions and uses intense heat, which carries a risk of airway fire
* Loss of airway smooth muscle mass is thought to reduce bronchoconstriction
53
* Serial _______ can be useful for monitoring response to treatment
PFTs
53
* When the FEV1 improves to about _____% of normal, pts usually have minimal or no symptoms
50
54
* Acute severe asthma:
bronchospasm doesn’t resolve despite usual tx
55
* Emergency tx consists of high-dose, ________ and __________
short-acting β2 agonists and systemic corticosteroids
56
Inhaled β2 agonists can be administered every _________ min for several doses w/o adverse hemodynamic effects, although pts may experience unpleasant sensations resulting from ________________
15-20;
adrenergic overstimulation
57
IV corticosteroids are administered early because ________ takes several hours
onset
58
* The 2 corticosteroids most commonly used: ___________ and _____________
hydrocortisone & methylprednisone
58
* Supplemental 02 is given to help maintain 02 saturation >____%
90
59
Other drugs used in more severe cases include ____________ and ________________
magnesium and oral leukotriene inhibitors
60
Treatment of Acute severe Asthma
60
______________ has been reported in 0.2-4.2% of asthmatics undergoing GA
* Bronchospasm
61
Risk of bronchospasm is correlated what type of surgery?
higher with upper abdominal and oncologic surgery
and how recent the last attack occurred
62
GA mechanisms that increase airway resistance:
depression of cough reflex,
impairment of mucociliary function,
reduction of palatopharyngeal muscle tone,
depression of diaphragmatic function,
and increased fluid in the airway wall
* Other factors include: airway stimulation by intubation, PNS activation, and/or release of neurotransmitters such as substance P and neurokinins also play a role
63
Preop evaluation of pts with asthma requires an __________, ___________ and ______________
assessment of disease severity,
effectiveness of current tx,
and the need for additional therapy before surgery
* Physical appearance and use of accessory muscles of should also be noted
64
* Auscultation of the chest to detect _____________ or _____________ is important
wheezing or crackles
65
_____________counts often mirror the degree of airway inflammation
* Eosinophil
PFTs (esp FEV1) before and after bronchodilator may be indicated.
66
What tests show a risk for periop respiratory complications
A reduction in FEV1 or forced vital capacity (FVC) to <70% of predicted,
and/or FEV1:FVC ratio <65% of predicted,
67
__________,___________, and ____________ can often improve reversible components of asthma.
Preop chest physiotherapy, antibiotics, and a bronchodilator
68
________ are indicated if there is any question about the adequacy of ventilation or oxygenation
* ABGs
69
* Anti-inflammatories and bronchodilators should be continued until _________
Induction
* If the patient has been on systemic corticosteroids within the past 6 months, a stress-dose hydrocortisone or methylprednisolone is indicated
70
Pts should be free of wheezing and have a PEFR of >_____% of predicted or their personal best value before surgery
80
71
Characteristic of Asthma to be Evaluated Preoperatively
72
Symptoms of COPD include:
emphysema characterized by lung parenchymal destruction,
chronic bronchitis,
productive cough,
and small airway disease
73
What are other contributing factors to COPD apart from smoking:
dust & chemicals,
asbestos,
gold mining,
biomass fuel,
air pollution,
genetic factors,
age,
female gender,
poor lung development during gestation,
low birth weight,
recurrent childhood respiratory infections,
low socioeconomic class,
and asthma
73
COPD leads to:
1) pathologic deterioration in elasticity or recoil within the lung parenchyma, which normally keeps the airways open
2) pathologic changes that decrease bronchiolar wall structure, allowing them to collapse during exhalation
3) increased velocity through the narrowed bronchioli, which lowers intrabronchial pressure and favors airway collapse
4) active bronchospasm and obstruction resulting from increased pulmonary secretions
5) destruction of lung parenchyma, enlarged air sacs, and development of emphysema
74
Sx of COPD vary with the severity but usually include: ___________, ____________, and ____________
dyspnea at rest or exertion,
chronic cough,
and chronic sputum production
75
COPD exacerbations are caused by _______________
acute worsening in airflow obstructions
76
As expiratory obstruction increases, ___________ and _____________ become evident
tachypnea and prolonged expiratory times
* Breath sounds are likely decreased, and expiratory wheezes are common
77
As the disease progresses, exacerbations become more frequent, and are often triggered by __________________
bacterial respiratory infections
78
Providers should have a high degree of suspicion and low threshold to test for COPD in pts with ____________ or _____________
dyspnea & chronic cough, or environmental exposures
* Definitive diagnosis is made with spirometry
79
* PFTs show a decrease in the ________ ratio and an even greater decrease in the FEF btw ___and____% of vital capacity
FEV1:FVC
25% and 75%
80
Common findings include: FEV1:FVC <____%, an increased _____ and ____, and _________ diffusing lung capacity for carbon monoxide (DLCO)
70%
FRC & TLC
reduced
* An increase in residual volume (RV) is d/t slow expiratory airflow and gas trapping behind prematurely closed airways
* This compensated increase in RV and FRC provides an enlarged airway diameter
* The cost is greater work of breathing at higher lung volumes
81
GOLD Spirometric Criteria For COPD severity
82
T/F: * CXR: abnormalities may be minimal even w/severe COPD
T
83
______________ in the lung periphery suggests emphysema
What confirms emphysema?
Hyperlucency
Bullae
* only a small percentage of pts with emphysema have bullae
84
_________much more sensitive at diagnosing COPD than CXR
CT Scan
* Although CT is not routinely used for COPD diagnosis, the
additional information it provides has prompted interest in expanding the protocol for all COPD cases
85
Multiorgan loss of tissue (MOLT) phenotype of COPD, is associated with:
airspace enlargement,
alveolar destruction,
loss of bone, muscle, and fat tissues,
and carries higher rates of lung cancer
86
Bronchitic phenotype is associated w/ ___________ and _____________ and is usually accompanied by metabolic syndrome and cardiac disease
bronchiolar narrowing and wall thickening
87
___________BODE scores indicate greater risk of exacerbations, hospitalizations,
and pulmonary death
* Higher
87
The BODE index is a grading system that looks at ___________, ___________, __________, and __________ to assess prognosis
BMI,
degree of obstruction,
level of dyspnea,
and exercise tolerance
88
Lab values:
* α1-antitrypsin deficiency is an inherited disorder assoc w/ COPD
* low α1-antitrypsin requires lifelong replacement therapy
* Eosinophils should be measured in pts with uncontrolled disease despite bronchodilator tx
* high eosinophils indicate the need for inhaled glucocorticoids
* low levels are assoc w/ increased risk of pneumonia
* ABGs often remain normal until COPD is severe
*Pa02 doesn't usually decrease until the FEV1 is <50% of predicted
* PaC02 may not increase until the FEV1 is even lower
89
COPD tx is designed to alleviate symptoms and slow progression
uhuhh
* The 1st step is reducing exposure to smoke and environmental pollutants
o Smoking cessation can decrease dz progression and lower mortality by up to 18%
90
COPD Tx:
* Inhaled tx’s can improve sx, improve FEV1, and reduce exacerbations
* Other tx’s include flu & pneumonia vaccines
* Diuretics are helpful if RHF or CHF has developed
* During exacerbations, abx, corticosteroids, and theophylline may be necessary
* Pulmonary rehab programs are beneficial as they can increase exercise capacity
91
COPD Tx:
92
In pts w/severe refractory COPD and overdistended lung tissue, ____________ may be required
lung volume reduction surgery
* Surgical removal of these overdistended areas allows more areas of normal lung to expand and improve lung function
93
* Lung volume reduction surgery is most commonly performed via a _____________ or ______________
median sternotomy or a video-assisted thoracoscopic surgery (VATS)
94
* Mechanisms for improvement in lung function include:
1) increased elastic recoil, which increases expiratory airflow
2) decreased hyperinflation, which improves diaphragmatic and chest wall mechanics
3) decreased ventilation/perfusion mismatch, improving alveolar gas exchange
95
Anesthesia mgmt for lung-volume reduction surgery includes:
a double-lumen ETT,
avoidance of nitrous oxide,
and minimizing excessive airway pressure
CVP in an unreliable guide for fluid management in this situation due to surgical
alterations that will affect intrathoracic pressures
96
COPD Anesthesia Management
97
Indications for preop pulmonary evaluation typically include:
1) hypoxemia on room air or the need for home 02 without a known cause
2) a bicarbonate >33 mEq/L or PC02 >50 mmHg w/o diagnosed pulmonary dz
3) a history of respiratory failure d/t an existing problem
4) severe shortness of breath attributed to respiratory disease
5) planned pneumonectomy
6) difficulty assessing pulmonary function by clinical signs
7) the need to distinguish causes of respiratory compromise
8) the need to determine the response to bronchodilators
9) suspected pulmonary HTN
98
Pts with COPD undergoing peripheral surgery do not require preop PFTs
When in doubt, spirometry with FEV1 can be sufficient to assess lung disease
ya!
99
Patient related Risk factors for Development of Post-op pulmonary complications
Age >60
ASA higher >2
CHF
Pre-existing pulmonary disease (COPD)
Cigarette smoking
100
Procedure related Risk factors for Development of Post-op pulmonary complications
Emergency surgery
Abdomen or Thoracic surgery, head and neck surgery, Neurosurgery, vascular/aortic aneurysm surgery
Prolonged duration of anesthesia (>2.5hr)
General anesthesia
101
test predictors Risk factors for Development of Post-op pulmonary complications
Albumin level of <3.5 g/dL
102
Strategies to reduce post-op complications:
103
______% of smokers undergo GA annually
* 5-10
* This offers a window of opportunity for a smoking intervention, which should encourage the pt to stop smoking before surgery and permanently if possible.
* Evidence shows that the earlier the intervention, the more effective it is in reducing postop complications and maintaining cigarette abstinence
104
* The maximum benefit of smoking cessation is not usually seen unless smoking is stopped at least ___________ prior to surgery
8 weeks
* Smoking is the single-most important risk factor for developing COPD and death caused by lung disease
105
The adverse effects of carbon monoxide on 02-carrying capacity and of nicotine on the CV system are _________
short-lived.
* The sympathomimetic effects of nicotine on the heart last 20-30 minutes
* The elimination half-life of carbon monoxide is 4-6 hrs
106
Within 12 hours after cessation of smoking, the Pa02 at which HGB is 50% saturated with oxygen (P50) increases from ________ to ________, and plasma levels of carboxyhemoglobin decrease from _____ to ______
22.9 to 26.4 mmHg
6.5% to 1%
* Despite the favorable effects on plasma carboxyhemoglobin, short-term abstinence from cigarettes has not been proven to decrease postop pulmonary complications
107
* Cigarette smoking causes _________, __________, and _____________
mucous hypersecretion, impairment of mucociliary transport, and narrowing of small airways
* It takes weeks of abstinence from smoking to see improved ciliary and small airway function and decreased sputum production
108
T/F: Smoking does not interfere with normal immune responses and the ability to respond to pulmonary infection following surgery
False!
It does
109
Return of normal immune function requires at least ___________ of abstinence from smokin
6 weeks
110
Some components of cigarette smoke simulate liver enzymes!
It may take ________ or longer for hepatic enzyme activity to return to normal
6 weeks
111
The optimal timing of smoking cessation before surgery to reduce postop pulmonary complications is ______________
Maximal effects?
6-8 weeks (max benefit @ 8 weeks)
112
* Smokers scheduled for surgery in ________ should be advised to quit and offered interventions such as behavioral support and pharmacotherapy
<4 weeks
* Nicotine replacement therapy (patches, inhalers, nasal sprays, lozenges, gum), is generally well tolerated
113
Sustained-release _________ can also help *
The drug is typically started __________ before smoking is stopped
bupropion
1-2 weeks
114
T/F: Although long-term smoking cessation offers clear advantages, there can be disadvantages in the immediate preop period
T
* These include increase in sputum production, inability to handle stress, nicotine withdrawal, irritability, restlessness, sleep disturbances, and depression
115
* Bronchiectasis is associated with irreversible ________, _________, and _____________
airway dilation, inflammation, and chronic bacterial infection
116
Prevalence is highest in pts >_____ yrs with chronic pulmonary dz s/a COPD & asthma, and in women
60
117
Sx of bronchiectasis:
chronic productive cough with purulent sputum,
hemoptysis,
clubbing
118
* Baseline ____ and _____should be obtained on all suspected Bronchiectasis pts
Baseline CXR and PFT
* Sputum culture should be checked for any active infection
119
______________ and _____________ leads to a vicious cycle of recurrent bacterial infection causing further inflammation, bronchial dilation, airway collapse, airflow obstruction, and the inability to clear secretions
poor mucociliary activity
mucous pooling
* Once a bacterial superinfection is established, it is nearly impossible to eradicate, and daily expectoration of sputum persists
120
What is the gold standard for bronchiectasis diagnosis ?
* CT is the gold standard for diagnosis; It usually shows dilated bronchi
121
what are key treatments for bronchiectasis?
antibiotics
and chest physiotherapy
to improve expectoration
122
Other tx:
yearly flu vaccine,
bronchodilators,
systemic corticosteroids,
and 02 therapy
* Results of sputum cultures guide antibiotic selection
* Surgery is considered only in the rare instance where severe symptoms persist, or recurrent complications occur
123
What is cystic fibrosis?
autosomal recessive disorder of the chloride channels leading to abnormal production and clearance of secretions
124
caused by a mutation of a gene on chromosome ____ that encodes the cystic fibrosis transmembrane conductance regulator (CFTR)
7
125
Normally, CFTR produces a protein, which aids in ________ and ________ movement in and out of cells. In CF, the mutated CFTR gene results in the production of abnormally thick mucus outside of epithelial cells
salt and water
126
Decreased chloride transport is accompanied by decreased transport of _______ and _________, which leads to dehydrated viscous secretions, luminal obstruction, and destruction and scarring of various glands and tissues
sodium and water
* The end result can lead to severe organ damage manifested as bronchiectasis, COPD, sinusitis, diabetes, cirrhosis, meconium ileus in children, and azoospermia
127
Exocrine pancreatic insufficiency leads to malabsorption of __________ and ________
fats & fat-soluble vitamins
128
* The primary cause of morbidity and mortality is ____________
chronic pulmonary infection
129
* Diagnostic criteria: a sweat chloride concentration >_______along with clinical sx
_____, _______, _____) or family history of the disease
60 mEq/L
(cough, purulent sputum, exertional dyspnea
* Deoxyribonucleic acid (DNA) analysis can identify >90% of pts with CFTR mutation
130
_________ with a response to pancreatic enzyme tx is evidence of pancreatic exocrine insufficiency associated with CF
* Malabsorption
131
_____________, confirmed by testicular biopsy, is also strong evidence of CF
* Obstructive azoospermia
132
* Bronchoalveolar lavage typically shows a high percentage of __________, which is a sign of airway inflammation
neutrophils
133
Cystic Fibrosis treatment:
Sx control,
pancreatic enzyme replacement,
02 therapy,
nutrition,
prevention of intestinal obstruction
* Gene therapy is currently being investigated
134
T/F: COPD is present in virtually all adult CF pts
T
135
The _____________ abnormalities of the sputum causes retention resulting in airway obstruction
* The viscoelastic
136
* The main nonpharmacologic approach to enhancing clearance of secretions is __________
chest physiotherapy with postural drainage
* Bronchodilators can be considered if pts are known to have a beneficial response to inhaled bronchodilators (if more than 10% ore more in FEV1 after bronchodilator)
137
* The thick viscosity of secretions is c/b the presence of __________ and ___________
neutrophils
degradation products
* DNA released from neutrophils forms long fibrils that add to the viscosity
138
______________ can cleave this DNA and increase the clearance of sputum
* Recombinant human deoxyribonuclease
* Antibiotics are given based on the identification of bacteria isolated from sputum
139
If cultures show no pathogens, __________ to remove lower airway secretions may be indicated
bronchoscopy
* Many pts with CF are given long-term maintenance abx to suppress chronic infection
140
Elective surgery should be delayed until optimal pulmonary function is ensured by controlling infection and facilitating removal of airway secretions
Makes sense
141
___________ of inspired gases, __________, and avoidance of ___________are important steps in maintaining less-viscous secretions
Humidification
hydration
anticholinergic drugs
* Frequent tracheal suctioning may be necessary
141
_________ may be necessary if hepatic function is poor or exocrine pancreatic function is impaired
Vitamin K
142
________________ is important to allow for deep breathing, coughing, and early ambulation so that pulmonary complications are minimized
Postop pain control
143
Primary Ciliary Dyskinesia is:
Congenital impairment of ciliary activity in respiratory tract, epithelial cells and sperm tails and ciliated ovary ducts
144
_________________ is the Triad of chronic sinusitis, bronchiectasis, and situs inversus (chest organ position is inversed)
Kartagener syndrome
* Approximately ½ of pts with congenitally nonfunctioning cilia exhibit situs inversus
145
____________ is almost always associated with congenital heart disease
Isolated dextrocardia
146
Preop preparation for primary ciliary dyskinesia is directed at ___________
treating pulmonary infection and determining if
significant organ inversion is present
147
In the presence of dextrocardia, EKG position is ________ for accurate interpretation
reversed
148
Inversion of the great vessels is a reason to select the left IJ vein for CVC
Normally the right IJ is preferred as it leads straight to the SVC
149
Uterine displacement in pregnant women should be to the right
Normally LUD is implemented to avoid vena cava syndrome
150
* If a double-lumen ETT is needed, pulmonary inversion may indicate R DLT placement
Typically, L DLT is preferred b/c the R mainstem is shorter and RUL more easily obstructed
151
* Due to the high incidence of sinusitis, ___________- should be avoided
nasopharyngeal airways
152
Bronchiolitis Obliterans
Results from epithelial and subepithelial inflammation leading to bronchiolar destruction and narrowing
153
Risk factors for Bronchiolitis Obliterans
viral respiratory infections,
environmental exposures,
lung transplant,
and stem cell transplant
* Sx are nonspecific and include dyspnea and nonproductive cough
154
PFTs usually show ____________ and includes a ___________ FEV1 and FEV1:FVC ratio that is unresponsive to bronchodilators
obstructive disease
reduced
* High-resolution CT shows air trapping and bronchiectasis in severe cases
155
Central Airway Obstruction
includes obstruction of airflow in the tracheal and mainstem bronchi
* 20-30% of lung cancer pts can be affected by airflow obstruction
156
* Obstructive c/b:
tumors,
granulation from chronic infection,
and airway thinning from cartilage destruction
157
___________ can develop after prolonged intubation either with an ETT or a tracheostomy tube
Tracheal stenosis
158
Tracheal mucosal ischemia can progress to destruction of _____________ and subsequent circumferential _______ formation
cartilaginous rings,
scar
159
This is minimized by the use of ____________ on ETTs
high-volume, low-pressure cuffs
160
* Tracheal stenosis becomes symptomatic when the lumen is decreased to <____mm in diameter
5
* Symptoms may not develop until several weeks after extubation
* Sx of dyspnea is prominent even at rest
161
T/F: Accessory muscles are utilized throughout all phases of the breathing cycle
T
Stridor is usually audible
Flow-volume loops typically display flattened inspiratory & expiratory curves, which is characteristic of a fixed airway obstruction
* CT will illustrate tracheal narrowing
162
Tracheal Stenosis:
163
Key Point:
