Term
| A defect in the chloride ion transport in the epithelial cells (of the lungs, pancreas, liver, GI tract and reproductive organs) that is accompanied by a reduction in sodium and water transport which results in dehydrated, viscous secretions associated with luminal obstruction |
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Definition
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Term
| The primary cause of morbidity and mortality in CF patients |
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Definition
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Term
| True or False: Cystic fibrosis is primarily a form of obstructive respiratory disease WITH restrictive components? |
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Definition
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Term
| Cystic fibrosis leads to... |
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Definition
- bowel obstruction
- decreased nutrition absorption
- difficulty clearing airway
- scaring of exocrine glands
- pancreatic insufficiencies
- diabetes
- cirrhosis
- portal HTN
- azospermia
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Term
| The most common life-shortening autosomal recessive disorder (30,000 Americans) resulting from a mutation on chromosome 7 |
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Definition
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Term
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Definition
- High sweat chloride concentration
- Cough, chronic purulent sputum, exertional dyspnea
- Sinusitis (frequent)
- Bronchial lavage=Many neutrophils
- Exocrine symptoms that respond to treatment
- COPD is present in nearly ALL adults with CF and is relentlessly progressive
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Term
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Definition
- Clearance of airway secretions
- Bronchodilators (if improvement in PFTs by 15%)
- Reduction in viscosity (mucolytics)
- Antibiotics (CF results in frequent pulm. infections)
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Term
| What (2) techniques are helpful in mobilizing the the thick respiratory secertions that accompany CF? |
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Definition
Postural drainage & chest percussions
(performed pre- and post-op) |
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Term
| What vitamin absorption is decreased in CF patients creating increased bleeding risks? |
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Definition
Vitamin K
(Factors dependent: 2, 7, 9, & 10) |
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Term
| Anesthetic implications with cystic fibrosis |
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Definition
- Delay elective procedures until optimized
- Vitamin K
- Preop medications (be aware that opioids/sedatives have synergistic effects and can produce more bronchiectasis)
- Use of anticholinergics can make sputum more thick (atropine & glycopyrolate)
- Humidification
- Suctioning (frequent)
- Hydration
- Endocrine management (checking blood sugar)
- Volatile anesthetics are a GOOD choice (decrease reactive airway response, promote bronchodilation and reduce airway resistance)
- AVOID histamine releasing drugs (Succs...morphine)
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Term
| Diagnositic signs of acute respiratory failure |
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Definition
- PaO2<60 torr despite supplemental oxygen and NO intracardiac right to left shunt
- PaCO2 can be normal, low or elevated, but a PaCO2>50 torr in the absence of respiratory compensation for metabolic alkalosis and hypoventilation
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Term
| True or False: Acute respiratory failure can be differentiated from hypoventilation by looking at the alveolar and arterial CO2 and PO2 gradients? |
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Definition
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Term
| True or False: The PO2 gradient is used because it is NOT affected by FiO2 levels? |
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Definition
| False; the PCO2 gradient is used because it is NOT affected by manipulating FiO2 levels, whereas the PO2 gradients obviously are. |
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Term
PaCO2 level is elevated
&
pH represents acidosis |
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Definition
| Acute (respiratory) Failure |
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Term
| pH is normal d/t metabolic compensation |
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Definition
| Chronic (respiratory) Failure |
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Term
| Respiratory failure is accompanied by: |
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Definition
- Decreased FRC
- Decreased lung compliance
- Pulmonary HTN
- PA pressures usually increase
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Term
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Definition
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Term
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Definition
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Term
| Alveolar membrane damage, leaking of protein rich edema fluid into the alveoli resulting in noncardiogenic pulmonary edema |
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Definition
| Acute Respiratory Distress Syndrome (ARDS) |
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Term
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Definition
- Aspiration of gastric contents (aspiration pneumonitis)
- pneumonia
- pulmonary contusions
- indirect lung injury (sepsis)
- trauma with severe shock and multiple blood transfusions (TRALI or full ARDS)-TRALI resolves quickly (24hrs.); ARDS does NOT
- cardiopulmonary bypass
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Term
| Arterial hypoxemia is resistant to treatment with supplemental oxygen. The CXR looks like pulmonary edema on X-ray |
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Definition
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Term
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Definition
- Correct hypoxemia: Providing supplemental oxygen to maintain a PaO2 of > than 60 mmHg leading to a saturation of > 90%. If supplemental oxygen does NOT work, progress to CPAP or intubation with PPV
- Remove excessive CO2 (mechanical ventilation may be required)
- Provide patent upper airway
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Term
| Why does pushing the PaO2 levels to > 80 torr (as opposed to goal of 60 torr) of little benefit? |
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Definition
| Oxyhemoglobin curve 'levels off' around 60 torr and there is minimal change in oxygen saturation levels at 80 torr |
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Term
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Definition
- high oxygen concentrations destroyed alveolar membranes (oxygen radicals etc.)
- tidal volumes are equally damaging (TV of 10-12 ml/kg
- peak airway pressures >50cm H2O can cause alveolar overdistension
RECOMMENDATIONS: Ventilate at a volume of 5-8 ml/kg to a pressure of 30cm H2O and accept the elevation in carbon dioxide-PERMISSIVE HYPERCARBIA |
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Term
| Other ARDS management tools |
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Definition
- Sedation
- Chest tubes to prevent barotrauma with increased PPV
- Paralysis (eleminates muscle resistance)
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Term
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Definition
5cm H2O
(typical settings need to overcome a person's physiological PEEP to have an impact) |
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Term
| MSU study on '...Alveolar Recruitment Maneuvers' |
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Definition
- CRNA's believe that positioning impacts atelectasis (supine & trendelenburg)
- CRNA's believe that obesity impacts atelectasis
- CRNA's do not correlate high FiO2 with atelectasis (perfusion atelectasis is not understood)
- Poor knowledge of recruitment maneuvers
- More practitioners do recruitment maneuvers in obese patients ONLY when clinically necessary (as opposed to preventatively)
- CRNA's may not be familiar with the terms "recruitment measures"
- CRNA's whose data was not used (incomplete responses) may suggest they simply don't have the knowledge
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Term
Atelectasis recruitment measures
(MSU study) |
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Definition
- Minimum of 40cm H2O pressure for minimum of 7-10 seconds
- To sustain, PEEP of 8-10cm H2O
- In obesity, the combination of the two (above) are better than either alone
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