questions resp. therapy 2

8/12/2019 questions resp. therapy 2

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What settings do you have to set for PSV ?



O2-Beimischung / FiO2 Rampe (Inspirationsflow)

inspiratorische Druckunterstütung Inspirationstrigger

!""! "#spirationstrigger

optional$ %iel&olumen optional$ Backup-'entilation



FiO2PS

PEEP

RampeTrigger i

Trigger e

TGV

Backup



What effects can be achieved with PSV mode?



• Relief of the respiratory muscles

• decrease the work of breathing

• improvement of ventilation

• improvement of CO elimination

• under certain conditions an improvement in the o!ygenation

• better synchronicity between the patient and respiratory dyspnea"

• higher respiratory drive as opposed to controlled ventilation



Please describe the boundaries of the PSV ventilation mode#



$he work of breathing is often underestimated%

• uring the trigger

• incorrect setting of ramp

•

* e#pirator* efforts uring the (late) inspiration+ especiall* in ,O!D• * e-s*nchroniation phenomena with tach*pnea ela*e inspirator*

pressure support

• with an intrinsic-!""!

• .ometimes no complete relief of the respirator* muscles can e achie&e

e&en with a high pressure support 0 complete relief can onl* * otaine

a controlle &entilation form (such as BI!0! 1+ 0!,') In some cases+

the ecision must e mae epening on the situation

• ,ontrolle &entilation forms show a higher recruitment



&ow is CO transported in the blood?



CO '$r nsport

• () * physically saturated in blood

• CO is ( times soluble as O in water+

• )* bound to hemoglobin ,Carbamino'&-.

• /)* chemically bound as bicarbonate



0ind the cause of%

1etabolic acidosis%

• 2dditions acidosis%

1esenterialinfarkt

3etoacidosis

4actateacidosis

1ethanol poisoning

• Subtractions acidosis%

• diarrhea

• 4oss over pancreas or small

intestine

• Retentions acidosis%

• acute kidney failure

1etabolic alkalosis% diuretica therapy

5atrogene overcompensation

&igh dose mineralkortikoide

Respiratory acidosis% acute hypercapnie

Respiratory alkalosis% hyperventilation



What is the 4ingula?



4ingula ,small tongue.

4ower 6aw7777lingular mandbula

small brain777++lingual sphenoidalis

4eft lung middle7pulmonary lingual sinstri









Please describe the difference between functional right'to left

shunt and dead space ventilation+

What is a 8shunt in time8?



5ntra pulmonal ,functional. right left shunt ,perfusion 8without8

ventilation.% 9ystelektase : atelectasis dead space vent% pulmonary

artery embolism ;

shunt in time shock ,ventilation 8without8 perfusion.% functional

shunt volume of short'term e!spiratory small airway closure+



identify and e!plain the components that affect the

diffusion of gas in the conte!t of pulmonary gas e!change#

Why is it important that the 3rogh coefficient of carbon

dio!ide is significantly higher than of o!ygen in this

conte!t?



1<3!,0:9. =p

1< diffusion

3<krogh diffusions coefficient

0<surface

9<thickness

1<diffusion

=p < difference in partial pressure

2 representative measure of the gas e!change is the partial pressure+O!ygen< pO carbon dio!ide < pCO

$he coefficient is > times higher carbon dio!ide then for o!ygen+ $his

ensures that despite the fact that CO has () times less partial

pressure than O" in the short time available during which erythrocytes

travel through the lung capillaries" a sufficient !change takes place+



Please describe the terms of compliance" resistance and elasticity

using a formula#



C < =V:=p

Pressure that must be applied to achieve a certain change in

volume in the lungs+

• Property of the lungs and thoracic cage,elasticity" 8Rigidity8.

< (:C

R < =p:flow

Pressure change necessary for the air to enter the lungs at a

certain velocity

• Property of the respiratory system



&ow high is the Pleura pressure in the various stages of respiration?

&ow important are these pressures for the physiological breathing?



5nspiration < '@ to 'A mbar

e!piration < '> to 'B mbar

this causes the 4ung to stick to the pleura wall7+



Which information can be deduced from the central venous o!ygen

saturation?

e!plain short and concise what you can conclude from this value#



enerally deduce the global tissue o!ygenaton level

drop%

mismatch between O supply and consumption

• drop of O supply and:or rise in usage



what two parameters do you use to determine the correct 0iO

setting

what is the standard value for both parameters+

paO% age'dependent ,()) mm&g ' B mm&g:9ecade of life.

or ()) mm&g ' half age

CaO% appro!+ (D* ,(D) ml o!ygen : ())) ml blood.

• ,CaO. calculation < ,&gb ! (+>E ! SaO. F ,)+))>( ! PaO.



name three ailments which benefit from a higher PP

• these diseases are in different anatomical areas of the

respiratory tract and the lungs+

1ention the anatomical areas where PP e!erts its affects+

OS2S,obstructive sleep apnea syndrome.% Pharyn!

Pulmonary emphysema% $erminal bronchial

Pulmonary edema% alveoli



-5

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..._ et$$

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!peak !mean

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o

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on(er-

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.424 .413

10

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"103

-10

-20-30

-40

-42

V entilator Eintellung

ftotal fspn!""!8

12 0 LowFlow !'99:/oop

f 50

?....

x MV MVspn 'erneler

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15 J21=10

5 !peak !mean

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.oner- funkt8onen

SO U!n Flow 5 o Flow .#1$.. VT VTe

40 J21=

.32" .33320

·101.03

-10 ftotal " spn !""!8-20

-30-40

1! 1! :ow Flow!'-:oop

-50

f 50

V entilator Eintellung ? ..... & MV MVspn 'erneler

'.(1 '.(13# #

$e%te

1.90

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einstellung < 12.! '2.2=ag I

;aeht

39



50

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Gou want to calculate the consumption of o!ygen in a patient#

What parameters that can be measured in a clinical routine" are

reHuired for such purpose?

$he naming of the parameters and their relationship to each other

is sufficient" a specific calculation is not reHuired+

P t l l ti I l



Parameter calculation Iormal

range2rterial o!ygen content ,&gb ! (+>@ ! SaO. appro!+ (A

ml : dl

,CaO. F ,)+))>( ! PaO.

2vailable o!ygen ,9O. &JV ! CaO D)) ml : min

Venal o!ygen content appro!+ (>

ml : dl arteriovenous difference in o!ygen CaO'CvO EB ml : dlO!ygen consumption (>) ! -S2 B) ml : min

K-S2<,EL3g.F/M

3g F D)

Please describe the structure of the alveoli?



2lveoli are spherical structures that have common walls and SP$2

,interalveolarsepten.+ $he SP$2 are made of a thin layer of

connective tissue" which is surrounded on both sides by an alveolar

epithelium of Pneumocytes+ 9ense capillary networks are

integrated into the layer of connective tissue+ 83ohn pores8 are

fine pores in the 2lveolar septum that connect ad6acent alveoli+

$hey support the parallel ventilation and the uniform distribution of

the air between the alveoli" may also help in the distribution of

surfactant+







surfactant is an integral part of the respiratory system of our body+

Please summariNe the most important aspects of following points%

where is it produced

composition

daily uantity produced

tasks

importance in in'and e!piration







Surfactant is a lipoprotein that lines the inner surface of the

2lveolus makes it easier to stretch the alveoli+

• ()'(B ml:kg a day

• Synthesis% 2lveoloNyten type 55

• with decreasing radius of the 2lveolus ,e!halation. the

thickness of the surfactant film causes a decrease in the

surface tension of the alveolar wall" preventing a collapse of



surface tension of the alveolar wall" preventing a collapse of

the alveola

• Strengthen bodys defenses:barrier against microorganisms

• antio!idant effect

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questions resp. therapy 2