Comp+ breathing
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Compliance refers to the change in lung volume for a given change in pressure. It is the reciprocal of elastance. Compliance of the respiratory system (CRS) depends on the interaction of lung compliance (CL) and chest wall compliance (CW). CL is affected by lung volume, surface tension, blood volume, and edema, while CW is affected by posture, obesity, costal cartilage ossification, and scarring. Dynamic compliance includes the effects of resistance and hysteresis during breathing, while static compliance is measured without gas flow at equilibrium. The difference between static and dynamic compliance reflects airway resistance.
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FORMULA
It is expressed as VA/Q.
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Normal value of ventilation perfusion ratio is about
0.8
VA is 4.2 L /min
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So VA/Q = 4.2/5.5 = 0.8
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In certain diseases the VA/Q ratio is higher which means perfusion is inadequate i.e. in some parts of lungs the alveoli are non functional or partially functional. This is seen in cases of pulmonary thrombosis or embolism.
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3. Shunts occur when blood is perfused but not ventilated, resulting in hypoxemia. The magnitude of shunt can be estimated by measuring venous admixture.
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Normal value of ventilation perfusion ratio is about
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So VA/Q = 4.2/5.5 = 0.8
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In lower part of lungs, there is more blood flow so the ratio is decreased may be 0.6.
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3) Some of the potential adverse effects of mechanical ventilation like barotrauma, hypotension from reduced preload, and increased dead space from high alveolar pressures.
ventilator_Omar_2016.ppt
This document discusses mechanical ventilation, including:
1) The basics of invasive positive pressure ventilation (IPPV) and noninvasive positive pressure ventilation (NIPPV) and how they help reduce work of breathing and restore gas exchange.
2) Important considerations for initiating IPPV including indications like respiratory failure and risks like hypotension and lung injury.
3) Key principles of mechanical ventilation including the equation of motion, partitioning work between the ventilator and patient, and common modes of ventilation.
Basic terms and concepts of mechanical ventilation
This document defines key concepts and terms related to mechanical ventilation. It discusses normal lung mechanics including compliance, resistance, and time constants. It describes different types of ventilation such as negative pressure ventilation, positive pressure ventilation, and high-frequency ventilation. It also defines important pressures measured during mechanical ventilation such as peak pressure, plateau pressure, and pressure at the end of exhalation. The document provides an overview of the basic science underlying mechanical ventilation.
Basic mechanical-ventilation
Mechanical ventilation can help reduce the work of breathing and restore gas exchange by using positive pressure. There are two main types: invasive positive pressure ventilation (IPPV) and noninvasive positive pressure ventilation (NIPPV). Positive pressure ventilation aims to address indications like unstable airways, respiratory acidosis, and hypoxic respiratory failure. However, it also carries risks like reduced venous return, barotrauma, and ventilator-induced lung injury that require monitoring. Common modes include assist-control, SIMV, PCV and pressure support which vary in how they partition the work of breathing between the patient and ventilator. Key parameters to monitor include tidal volume, plateau pressure, and auto-PEEP.
Mechanical ventilation Basics and waveforms
This document defines key terms and concepts related to mechanical ventilation. It discusses pressures such as airway opening pressure, intrapleural pressure, transpulmonary pressure, and others. It also describes lung characteristics like compliance and resistance. The document outlines the basics of negative and positive pressure ventilation. It discusses variables that control the ventilator cycle, including triggers, limits, and cycles. Finally, it examines various waveforms produced by mechanical ventilation like pressure/time scalars and esophageal pressure curves.
Compliance
Continuous, reliable measurement of static compliance of the lung and thorax is essential in mechanical ventilation. Dynamic compliance is dependent on airway resistance and can be misleading. An inflation hold maneuver measures static compliance by holding air in the lungs at the end of inspiration to measure plateau pressure. Poor compliance can indicate collapsed or overdistended lungs, while surfactant improves compliance and reduces pressure needs.
Part 3compliance 3
Continuous, reliable measurement of static compliance of the lung and thorax is essential in mechanical ventilation. Dynamic compliance is dependent on airway resistance and can be misleading. An inflation hold can measure static compliance by determining the plateau pressure needed to deliver a tidal volume. Compliance indicates lung condition - less compliant lungs in RDS require higher pressures to deliver tidal volumes, while surfactant improves compliance.
Conv. ventilation physi
This document discusses the physiology of positive pressure ventilation. It covers:
- The goals and types of mechanical ventilation including positive and negative pressure ventilation.
- Key concepts including pressure gradients, time constants, airway pressures, and the effects of PEEP.
- How mechanical ventilation supports gas exchange and manipulates work of breathing while minimizing cardiovascular effects.
- Different pressure, volume, and flow waveforms and how they impact ventilation.
- Common ventilator modes like volume control, pressure control, and how they are classified based on triggers, limits, and cycling variables.
Conv. ventilation physi
This document discusses the physiology of positive pressure ventilation. It covers:
- The goals and types of mechanical ventilation including positive and negative pressure ventilation.
- Key concepts including pressure gradients, time constants, airway pressures, and the effects of PEEP.
- Modes of ventilation including volume-controlled, pressure-controlled, and how they differ in terms of triggers, limits, and cycling.
- Waveforms including pressure, volume, and flow and how they are used to assess ventilation.
The document provides an overview of the fundamental physics and physiology principles underlying mechanical ventilation.
Body plethesmography
Body plethysmography is a technique used to measure lung volumes like intrathoracic gas volume (TGV) and airway resistance. It involves having the patient breathe in an enclosed chamber while measuring changes in pressure and volume. Specific airway resistance (sRaw) is determined from the relationship between respiratory flow and volume shifts in the chamber. Intrathoracic gas volume (ITGV) can also be measured by having the patient breathe against a shutter to create a closed system where changes in pressure and volume can estimate ITGV based on Boyle's law. Clinical applications include evaluating effects of pulmonary disorders on lung volumes like functional residual capacity (FRC) and residual volume (RV).
Mechanical Ventilation
The document discusses mechanical ventilation and the mechanics of breathing. It covers topics like spontaneous breathing, respiration, ventilation, gas flow and pressure gradients in the lungs during breathing, compliance, resistance, time constants, and different types of ventilators including conventional and high frequency ventilators.
Pulmonary graphics radha
This document provides an overview of pulmonary graphics and ventilator waveforms. It discusses the basics of how ventilator monitoring systems work and the importance of interpreting graphic displays. The key ventilator waveforms of pressure-time, volume-time, flow-time and pressure-volume loops are described. Specific features of each waveform are defined, and they can be analyzed to evaluate lung mechanics, respiratory system pressures, gas trapping, leaks, asynchrony, and other factors. Understanding ventilator graphics is critical for optimizing ventilator settings and managing mechanically ventilated patients.
wob.pptx
During normal breathing, inspiratory muscles contract to inhale air actively, while exhaling is passive. Work of breathing is low at around 1-2% of total energy expenditure at rest and 3-5% during exercise. Work of breathing can be divided into compliance work against lung elasticity, tissue resistance work overcoming tissue friction, and airway resistance work overcoming friction in airways. Conditions that increase work of breathing include decreased lung compliance, increased airway resistance from obstruction, or increased tissue resistance from thoracic abnormalities.
Learning Objectives Covered1. Explain the importance of monitor.docx
Learning Objectives Covered:
1. Explain the importance of monitoring plateau pressures and its use in calculating static compliance
2. Explain the use of volume-controlled ventilation and pressure-controlled ventilation
3. List and describe ventilatory support treatment plans for patient’s based on their clinical diagnosis
Background
Compliance is a measurement of the distensibility of the lung or the ability of the lung to distend. It is expressed as a change in volume divided by a change in pressure using the standard units of Liters/cmH20. The normal lung + thorax compliance of an adult is around 0.1 L/cmH20. When the compliance is low, more pressure will be needed to deliver a given volume of gas to a patient. Diseases that cause low lung compliance are classified as restrictive diseases and include Adult Respiratory Distress Syndrome (ARDS), pulmonary edema, pneumonectomy, pleural effusion, pulmonary fibrosis, and pneumonia among others. Emphysema is a typical cause of increased lung compliance.
When measuring lung compliance one must know the delivered tidal volume and must also know the change in alveolar pressure that results from the addition of that known tidal volume. Alveolar pressure is the pressure in the distensible parts of the respiratory tract and is determined by the tidal volume and the lung/chest compliance. Airway pressure is the pressure measured at the patient’s airway during mechanical ventilation. Airway pressure is equal to alveolar pressure when there is no occurrence of airflow. At the end of a mechanical inspiration, flow to the distal parts of the lungs continues even after inspiratory flow from the ventilator stops, as time is required for gas to reach the periphery of the lung. To measure alveolar pressure, one must measure the airway pressure at a time when both pressures are equal, i.e. when there is no flow.
We normally assume that alveolar and airway pressure starts out at atmospheric (our zero reference) before an inspiration starts. To equalize airway and alveolar pressures, we only have to prevent exhalation after inspiration has ceased by utilizing an inspiratory hold maneuver. The actual calculation is to divide the delivered tidal volume by the plateau pressure where the plateau pressure is the steady-state pressure measured during an inspiratory hold maneuver. Since approximate values are adequate for clinical use, clinicians use the plateau pressure minus the end expiratory pressure that is then divided into the exhaled tidal volume as measured by the ventilator. This compliance measurement is referred to as static compliance since it is measured after an inspiratory hold and there is no gas flow during its measurement.
Cstatic = exhaled VT (ml)
Pplat (cmH2O) – PEEP (cmH2O)
Where:
VT – Tidal Volume
Pplat = Plateau Pressure
A spontaneously breathing person has a normal compliance of approximately 100mL/cmH2O. In intubated patients, normal comp ...
Ventilator Graphics
The document discusses basic principles of mechanical ventilation including factors that can lead to ventilatory failure, airway resistance, lung compliance, hypoventilation, V/Q mismatch, intrapulmonary shunting, and diffusion defects. It also covers different types of ventilator waveforms including pressure, volume, flow and pressure/volume loops which can be used to assess a patient's respiratory status and response to therapy.
Equal pressure point
1) During forced exhalation, contraction of expiratory muscles increases pleural pressure above atmospheric pressure. This causes the transmural pressure gradient along the airways to become positive.
2) As air flows out of the alveoli, pressure inside the airways drops. At the "equal pressure point", airway pressure equals pleural pressure.
3) Downstream from this point, the positive transmural pressure gradient causes compression and collapse of smaller airways that lack support from elastic tissues, as seen in emphysema patients.
Compliance and resistance
The document describes two individuals' experiences with smoking and related health issues. Michael started smoking at age 9 and was diagnosed with COPD at age 44. He struggled to quit smoking until having a health scare at age 52 that prompted him to stop. He had lung surgery and is working to improve his health. The document also describes an unnamed woman who started smoking as a teenager and was later diagnosed with oral cancer at age 25 and throat cancer at age 40. She underwent radiation therapy and surgery but continued smoking and passed away from her health issues at age 53.
Mechanical ventilation in neonates
Informative ppt for Post Graduate students, trained doctors in pediatrics or neonatology . All doctors .
Resp Physio and PFTmade by me welcome to
This document discusses respiratory physiology and pulmonary function tests. It covers the mechanics of respiration including the roles of the diaphragm and accessory muscles. It also discusses the controls of respiration in the medulla and pons, and the factors that control the rate and depth of breathing like oxygen, carbon dioxide and pH levels. Nerve supply, intra-thoracic pressures, lung mechanics, compliance, volumes and classifications of lung defects are summarized. Common pulmonary function tests are then described like spirometry, plethysmography, diffusion capacity testing and what measurements each provides.
Similar to Comp+ breathing (20)
Basic terms and concepts of mechanical ventilation
Basic terms and concepts of mechanical ventilation
Learning Objectives Covered1. Explain the importance of monitor.docx
Learning Objectives Covered1. Explain the importance of monitor.docx
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This document presents the case of a 35-year-old male patient who presented with swelling and pain in the floor of his mouth for 4 days. He was diagnosed with Ludwig's angina and underwent incision and drainage surgery under awake fiberoptic intubation. Post-extubation, the patient experienced airway obstruction and respiratory distress requiring emergency tracheostomy. He developed negative pressure pulmonary edema but stabilized in the ICU. On post-op day 2, the patient exhibited agitated behavior and pulled out his tracheostomy tube due to underlying alcohol dependence syndrome.
Epidural (1)
This document provides information about epidural anaesthesia. It discusses the history and development of epidural techniques. It then describes the anatomy of the spinal cord, meninges, epidural space and sacral canal. It explains the mechanism of action of epidural anaesthesia and factors affecting drug distribution and elimination. Finally, it outlines the physiological effects of epidural anaesthesia on the cardiovascular, respiratory, gastrointestinal, genitourinary and neuroendocrine systems.
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This document provides guidelines for peer reviewers to evaluate original articles submitted to the Indian Journal of Anaesthesia. It includes a checklist of criteria to assess for various sections of the article like the title, abstract, introduction, methods, results, discussion, and references. Reviewers are asked to evaluate if the manuscript includes the necessary components for each section, follows ethical guidelines, and uses appropriate statistical analyses and language. The goal is to promote high-quality scientific writing while maintaining constructive feedback to authors.
Review roleija originalstudy
This document provides guidelines for peer reviewing original articles and clinical investigations submitted to the Indian Journal of Anaesthesia. It outlines key areas to check such as headings, title, abstract, keywords, and main sections of the article including introduction, methods, results, discussion, and conclusion. Reviewers are asked to check that appropriate approvals and consent were obtained, the study design and statistical analysis are sound, results are clearly presented, discussions are supported by citations, and references are formatted correctly. Guidelines also cover reviewing images, illustrations, videos andlegends.
Mcquade2017
This randomized crossover study compared end-tidal oxygen (ETo2) levels during preoxygenation with a bag valve mask (BVM) alone and with supplemental nasal cannula (NC) oxygen at different flow rates. Healthy volunteers underwent 3 minutes of preoxygenation with a BVM alone or a BVM with NC at 0, 5, 10, or 15 liters per minute. The primary outcome was ETo2 after 3 minutes of preoxygenation. NC flows of 0 and 5 L/min resulted in significantly lower ETo2 levels compared to the other groups. There were no differences in ETo2 between the BVM alone, NC 10 L/min, and NC 15 L/
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This document summarizes the case of a 72-year-old male patient who presented with injection abscess in his left gluteal region, lower limb cellulitis, and sepsis. He had a history of hypertension and diabetes. He underwent incision and drainage of the abscess 10 days prior and then developed fever, pain, swelling, and breathlessness. He was found to have pleural effusion, abdominal collections, and acute kidney injury. He underwent further surgical drainage and was managed in the ICU with antibiotics, fluid resuscitation, oxygen supplementation, and thoracic epidural anesthesia for pain management. His condition stabilized and he was successfully weaned off the ventilator the next day.
Arhi morb
Dr. Yasha, Dr. Tina, Dr. Arthi, and Dr. Janani treated a 55-year-old female patient with a retroperitoneal mass, septic shock, acute kidney injury (AKI), and severe metabolic acidosis. She presented with a history of diarrhea, vomiting, and decreased urine output. Imaging showed dilated bowel loops and ascites consistent with small intestinal obstruction. The patient was intubated, started on vasopressors, and underwent an exploratory laparotomy which revealed a retroperitoneal mass causing obstruction. Despite resuscitative measures including hemodialysis, bicarbonate infusion, and escalating vasopressors, her condition deteriorated and she
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The document discusses temperature monitoring and thermoregulation in the human body. It explains that body temperature depends on heat production and heat loss. The core body temperature is normally 36-37.5°C and vital organs must operate within this optimal range. When core temperature rises above 37°C, the hypothalamus activates mechanisms like sweating and vasodilation to increase heat loss and cool the body. When core temperature falls below 37°C, shivering and vasoconstriction occur to generate more heat and reduce heat loss. The hypothalamus precisely regulates these responses through negative feedback to maintain core temperature. General anesthesia disrupts all elements of thermoregulatory processing and control, which can lead
Journal 2
1. The document summarizes a journal club presentation which discussed different types of articles published in journals including editorials, review articles, original research articles, case reports, and letters to the editor.
2. It provided details on what constitutes each type of article and their purposes. For example, it stated that an editorial can critique other articles, review recent topics, and deliver concise messages from the editor.
3. The document also discussed other topics like how impact factor is calculated to measure a journal's importance, how to write a literature review, and the components of original research articles and case reports. It provided guidance on writing different types of academic articles and participating in journal club discussions.
Untitled
The study compared two dose regimens of tranexamic acid (TA) for reducing blood loss in hip surgeries: 1) a single 10 mg/kg bolus before incision, and 2) a 10 mg/kg bolus followed by a 1 mg/kg/hr infusion for 4 hours post-op. The bolus+infusion group saw significantly less blood loss at 6 hours post-op and higher hemoglobin levels at 6 hours. Both TA groups required fewer blood transfusions compared to the placebo group. The authors conclude that continuing TA infusion post-op is more effective at reducing early blood loss than a single pre-op bolus alone.
Arthi (1) copy
The document discusses thermoregulation and temperature monitoring. It summarizes that the hypothalamus regulates body temperature through heat production and loss mechanisms like radiation, conduction, convection, and evaporation. General anesthesia affects all aspects of thermoregulation by inhibiting responses like vasoconstriction and shivering that normally maintain core body temperature. This can lead to perioperative hypothermia if not prevented through measures like warmed fluids and surgical drapes.
Untitled
The study compared two dose regimens of tranexamic acid (TA) for reducing blood loss in hip surgeries: 1) a single 10 mg/kg IV bolus before incision, and 2) a 10 mg/kg IV bolus followed by a 1 mg/kg/hr infusion for 4 hours post-op. The infusion group saw significantly less blood loss at 6 hours post-op compared to bolus or placebo groups. Both TA regimens reduced 24-hour drain blood loss and need for blood transfusions compared to placebo. The authors conclude that a bolus plus infusion of TA maintains therapeutic levels longer to more effectively inhibit fibrinolysis and reduce early post-op bleeding in hip surgeries
Indian j anaesth60119-6203009_171350
- The document describes a study that assessed whether the antifibrinolytic drug tranexamic acid (TA) could reduce blood loss in patients undergoing surgery for head and neck cancer.
- 240 patients were randomly assigned to receive either TA or a placebo during surgery. Blood loss, need for transfusions, and coagulation parameters were compared between the groups.
- While post-operative blood loss was lower in the TA group, intraoperative blood loss and need for transfusions were similar between groups. Coagulation parameters indicated a hypercoagulable state in both groups.
Referral pain and phantom pain
1. Referred pain is pain perceived in a location other than where the painful stimulus originated. Common examples include pain from a heart attack referring to the left arm.
2. There are several proposed theories to explain referred pain, including axon reflex theory of shared nerve fibers and convergence-projection theory of shared spinal pathways. More recent theories involve central sensitization in the spinal cord.
3. Phantom limb pain refers to painful sensations felt in an amputated or missing limb. Approximately 60-80% of amputees report phantom limb sensations, with most being painful. Treatment is challenging but may involve drugs, nerve blocks, or spinal/brain stimulation in difficult cases.
Positioning in anaesthesia mgmc
The document discusses various patient positioning techniques used in anaesthesia and their goals, risks, and complications. It describes positions like supine, lithotomy, prone, lateral decubitus, and their effects on cardiovascular and respiratory systems. Common risks include nerve injuries, pressure sores, compartment syndrome, and visual complications. Careful patient assessment, padding of pressure points, monitoring for nerve injuries are emphasized. Position changes should be gradual and extremities checked regularly during long procedures to prevent injuries.
Paediatric breathing systems
- Dr. Phillip Ayre developed the T piece breathing system for children in 1937 after losing his own child to high gas pressures during anesthesia.
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- Common pediatric breathing systems include the T piece, Jackson Rees, Mapleson D and Bain circuits, and pediatric-modified circle systems. Low fresh gas flows can be used with these systems to decrease costs and heat/fluid loss while maintaining normocarbia. Proper selection and setup of the breathing system is important for safe anesthesia in children.
Paediatric anaesthesia practical tips
This document provides an overview of pediatric anesthesia considerations. It discusses key differences in pediatric physiology compared to adults, including higher oxygen consumption and metabolic rate in infants, differences in the cardiovascular and respiratory systems, and immature hepatic and renal function in young children. It also reviews airway anatomy variations, appropriate tube and LMA sizes, and pharmacokinetic considerations for commonly used anesthetic drugs in pediatrics. The principles of maintaining temperature, adequate oxygenation and IV fluids are emphasized for safe pediatric anesthesia.
Oxygen therapy
The patient may be developing CO2 narcosis due to suppression of hypoxic drive by high FiO2. Reduce FiO2 and consider non invasive ventilation. Monitor ABG.
Oxygen dissociation curve
This document discusses the oxyhemoglobin dissociation curve. It provides background on oxygen transport by hemoglobin and factors that influence the curve. Key points include:
- Hemoglobin transports oxygen through cooperative binding of up to 4 oxygen molecules per heme-globin molecule.
- The sigmoidal dissociation curve arises from cooperative binding - as one oxygen binds it increases affinity for others.
- Factors like pH, CO2, temperature can shift the curve left or right, altering oxygen unloading in tissues.
- Fetal hemoglobin has a higher affinity, helping oxygen transfer to the fetus in utero. Myoglobin also has higher affinity and acts as an oxygen storage in muscle.
Pain the basics
Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is classified in several ways including by type (nociceptive, neuropathic, psychogenic), duration (acute, chronic), and location. Theories of pain transmission include the specificity, pattern, and gate control theories. Pain signals travel along A-delta and C fibers to the spinal cord and then ascend to the brain via the spinothalamic tract. Descending pathways from the brainstem modulate pain transmission through the release of neurotransmitters like serotonin and norepinephrine.
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- 1. COMPLIANCE & WORK OF BREATHING Presentor: Arthi . P.R
- 2. COMPLIANCE Compliance - Change in Lung volume for the given change in atmospheric pressure It is the reciprocal of Elastance Compliance of the respiratory system = CRS Change in Lung Volume Change in Airway Pressure V P =
- 3. Compliance RS - Interaction of the compliance of lungs and compliance of chest wall Reciprocal of Compliance is the sum of reciprocal of Lung and Chest wall CL = Alveolar Presssure - Intrapleural Pressure CW= Intrapleural Pressure - Ambient Pressure Intrapleural Pressure is difficult to measure - Esophageal Pressure from Ballon Manometry is commonly used as an approximation of intrapleural pressure 1 CRS 1 CL 1 CW +=
- 4. Factors Affecting Compliance (CL) 1. Lung Volume - Compliance is related to Normal FRC 2. Surface Tension of Alveoli - Surfactant the major factor determining the Lung Recoil Without Surfactant Lung will normally behave like an air bubble following Laplace Equation P = 2T/R Normally- when radius of bubble decreases without change is surface tension the pressure increases But in Lung - When the radius decreases the surface tension also decreases and this opposes the collapse of smaller lung unit. P- Gas Pressure T- Surface Tension R- Radius
- 5. Other Factors Affecting Compliance (CL) 3. Pulmonary Blood Volume 4. Interstitial Edema Factors Affecting Chest Wall Compliance (CCW) 1. Posture 2. Obesity 3. Ossification of Costal Cartilages 4. Scaring of Skin
- 6. DYNAMIC COMPLIANCE Normal Healthy person- As the respiratory system inflates to 60% of the TLC - the chest wall is aiding the Muscle of respiration to inflate. Above this level the muscles of Inspiration should work to distend both the Lungs and the Chest wall - Dynamic Compliance P = Peak Airway Pressure - PEEP DC - Also include Effect of Airway resistance & Normal Hysteresis of Lung Parenchyma(Resistance to Change of Shape both during Stretch & Contraction) DC- Affected by frequency of Respiration & Velocity of Gas Flow
- 7. STATIC COMPLIANCE It is measured at a point of No gas flow and when the pressure gradient is allowed to Equilibrate to the entire airway. (Eg)In Anesthetised & Paralysed Patient during ventilation in VCV mode with a fixed inspiratory flow and using an end expiratory pause P = Plateau Airway Pressure - PEEP SC - refers to Actual Distending pressure in the patients alveoli Difference between Static & Dynamic Compliance reflects Airway resistance