Flashcards in Pulmonary Response to CPB- Exam 1 Deck (62)
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
What is the most common pulmonary complication?
How common is atelectasis?
What happens when lungs with atelectasis are re-expanded and ventilated?
Variable degree remains (microscopic/lobar)
Atelectasis results in impaired ___________.
Atelectasis results in decreased ______________(3). What percent after anesthesia? What percent after CPB?
Functional Residual Capacity; decreased by 20% after general anesthesia, by 40-50% after CPB
Atelectasis results in decreased _______________(2).
Atelectasis results in increased _________ (2).
What happens to the alveolar-arterial oxygen gradient in atelectasis?
Factors Contributing to Atelectasis: PREOPERATIVE
Smoking, chronic bronchitis
Cardiogenic pulmonary edema
Factors Contributing to Atelectasis: INTRAOPERATIVE
Anesthesia: reduced surfactant function
Monotonous ventilator pattern
Factors Contributing to Alelectasis: BYPASS
Plasma, lung distention, lung ischemia
Increased extravascular lung water ( complement activation)
heart rests on immobile left lower lobe
Open pleural cavity- accumulation of blood and fluid
What can we do to prevent atelectasis?
Decreased complement activation
Reduced chances of edema
Anesthesia has more control (i.e. how lungs are deflated and re-inflated)
What can anesthesia do to prevent atelectasis?
OLC (open lung concept)
Open Lung Concept
a method of ventilation intended to maintain end- expiratory lung volume by increased airway pressure.
When was "Pump Lung" a big problem?
What is "Pump Lung"
Acute respiratory failure
Lungs diffusely congested
Intra-alveolar and interstitial edema
Vessel lumina full of neutrophils
Diffuse swelling of endothelial cells
What might cause acute lung injury?
membrane damage from immune response
decreased pulmonary blood flow
elevated pulmonary artery pressure
What can emboli lead to?
Areas of ventilation/perfusion mismatching
What can cause the ventilation/perfusion mismatching from emboli?
What can greatly reduce degenerative lesions in lungs?
Introduction of arterial and cardiotomy filters
Better the ________-more normal the lungs.
Acute Lung Failure: Membrane Damage
Vasoactive compounds from PMNs
Oxygen free radicals
Ischemia reperfusion injury
Where is complement activation found?
Found wherever blood meets foreign surface
Ex. Hemodialysis, leukophoresis
What functions for fighting invading organisms does complement activation have?
makes bacterial cells vulnerable to phagocytosis by attaching various items
Lungs are ______ from pulmonary circulation during bypass.
(T/F) Lung tissue does not have any metabolic activity on bypass.
False, lung tissue still has metabolic activity
What is the lung metabolic activity on bypass at 36 C?