Restricted Airway Simulation

The presence of fluid in the alveolar space could potentially cause the lung capacity to be effected as well.

There are numerous different challenges that the paramedic will face in attempting to keep an airway patent. These challenges vary from patient to patient depending on their condition. One challenge in keeping a patent airway the paramedic will face is trying to maintain the airway of a trauma patient. Trauma patients make it difficult to maintain an airway due to the traumatic damage, especially if it has affected the face and neck regions.

ation that I will be discussing is Airway Pressure Release Ventilation (APRV). I have not had an opportunity to use this mode, so I thought I would research it for this assignment. “The degree of ventilator support with APRV is determined by the duration of the two CPAP levels and the mechanically delivered tidal volume. Depends mainly on respiratory compliance and the difference between the CPAP levels. By design, changes in ventilatory demand do not alter the level of mechanical support during APRV. When spontaneous breathing is absent, APRV is not different from conventional pressure-controlled, time-cycled mechanical ventilation”( Putensen, C. )APRV is a form of improved pressure ventilation allowing unrestricted spontaneous breath at an

The lung function tests showed a moderate degree of airflow obstruction with normal gas transfer factor which would be consistent with moderate degree COPD.

In conclusion, the airway hyperresponsiveness, odema of bronchial mucosa, increase mucus secretion, bronchospam will lead to airway obstruction hence it will result in patient having wheezes and dyspnoea.

Airway Pressure Release Ventilation (APRV) is an unconventional pressure controlled mode of ventilation that use inverse ratio strategy. Moreover, APRV based on the principle of open-lung approach, and it is a lung protective strategy mode. Therefore, one of the primary goals of APRV is to decrease the incident of Ventilator-induced lung injuries (VILI). Another purpose of APRV is that APRV aims to recruit the lung as well as to improve oxygenation. To illustrate, APRV creates continuous sequences of positive airway pressure that would significantly increase the mean airway pressure (Paw) which would lead to Lung recruitment and improve oxygenation. Furthermore, APRV helps to decrease the inflation/deflation process which contributes in avoiding alveolar derecruitment. In a similar way, APRV applies pressure to sustain FRC for alveolar recruitment. Finally, APRV helps patient to eliminate CO2 efficiently. On APRV, CO2 is washed during the release phase, and during spontaneous breathing as patients on APRV are allowed to breathe spontaneously at any time at the respiratory cycle on APRV. In Summary, The primary goals of Airway Pressure Release Ventilation are to minimize Ventilator-induced lung injuries cases, help to recruit lungs, improve oxygenation, avoid alveolar derecruitment, and eliminate CO2 efficiently.

Most patients undergoing general anesthesia for surgical procedures require mechanical ventilation. One of the biggest challenges facing clinicians providing mechanical ventilatory support today is managing the balance between providing adequate gas exchange and avoiding lung injury associated with positive pressure ventilation. Patients with respiratory failure need adequate tissue oxygenation and acid-base balance; however, the lungs are fragile structures that can be injured by over-distension, alveolar collapse and reopening, and high oxygen exposure. This challenge in providing “lung protective ventilation” is made more difficult by the fact that lung injury is often heterogeneous and thus what may benefit gas exchange in one region (e.g., higher pressure) may worsen injury in another.

5. Does the use of 1) small tidal volume ventilation or 2) pressure-limited ventilation strategies affect outcome in ALI related to infective airway diseases?

Spirometry is the most popular lung function test. The patient performs a maximal inhalation and then forcefully exhales as quickly and as long as they are able. The spirometer measures the volume of the air exhaled by patients. These measurements are taken at two intervals. The first measurement is the forced expiratory volume in one second (FEV1), records the volume of air exhaled after one second. The second measurement is taken at the point where the patient has fully exhaled the volume of inhaled air; this measurement is the forced vital capacity (FVC) (Harpreet Ranu et al.,

Figure 1 shows the responses of alveolar gas composition and haemoglobin-oxygen (Hb-O2) saturation to various ventilation conditions. All comparisons between various ventilation patterns were found to be statistically significant. The p-values, raw experimental data (n=44), and absolute and relative changes can be found in the Appendix. The mean baseline values, indicating normal breathing, for PO2 were approximately three times the mean PCO2. The values were 108.75  9.56 mmHg and 42.04  5.75 mmHg respectively. The mean baseline value for %O2 saturation was 97.93  1.64 % (Figure 1). For breath-holding following hypoventilation, mean PO2 and %O2 decreased and PCO2 increased when compared to normal ventilation. The values were 79.19

Necessary increase in ventilation to maintain blood gas homeostasis during exercise was compromised in some individuals resulting in a high work of breathing. When these ventilatoy demands exceed the capacity for the lung and chest wall to generate flow and volume, expiratory flow limitation can develop which may result in diaphragm fatigue. Expiratory flow limitation (EFL), is an important physiological phenomenon since it is associated with dynamic hyperinflation, which increases the work of breathing and causes dyspnea and potential exercise

The purpose of pulmonary function testing is to determine the overall function of the lungs as it relates to how much gas moves in and out of the lungs, how fast the gas exchange occurs, the stiffness of lung and chest walls, the diffusion characteristics of the alveolar-capillary membrane, and how well lungs respond to therapy (REF 15). Vital capacity of the lungs is measured when, after taking a long, deep breath, the patient exhales the maximum possible volume (REF 15). When the expiration of the volume is forceful, it is defined as forced vital capacity (FVC), which it is the most common way to measure vital capacity (REF 15). Mr. Kostas’ result of FVC 4.1L are only 85% of the expected normal value. FVC is reduced in patients with

The primary function of upper airway is to exchange heat and moisture. The ISB (isothermic saturation boundary) is the point that divides the airway by temperature which is constant below this point and is variable during inhalation and exhalation above this point. The shifts of the ISB can provide the proper heat and moisture in the upper airway to meet the needs in the lower airway. Without providing the correct heat moisture exchange between the upper and lower airway can lead to serious problems within the lungs. Humidification of dry medical gases which are administrated by inhaling is very important to keep the lower airway in a normal physiology condition; therefore, the proper heat and humidity helps maintain the normal function of the mucociliary transport system. Humidity therapy is also used to manage hypothermia and treat bronchospasm caused by cold air. Bland Aerosol Therapy involves the delivery of sterile water or saline aerosols by using large volume jet nebulizers and ultrasonic nebulizers to treat upper airway edema, provide proper heat and humidity in patients with tracheal airway, and help obtain sputum

There are two main categories of diseases that can affect the lungs, which are obstructive diseases and restrictive diseases. These lung diseases can have detrimental effects on the lung because they can result in decreased airway size, swollen or loss of alveolar sacs, and ultimately reduced gas exchange. Lung diseases, as well as the overall function of the lung can be evaluated using a method known as spirometry. Spirometry is a tool used to evaluate the breathing mechanisms of a patient and allow doctors to detect pulmonary diseases in patients displaying abnormal lung function. Spirometry can consist of static and dynamic tests to measure variables such as vital capacity, which is the highest volume of air that can be exhaled out of the

According to Egan’s, ventilation is the process of moving gas (usually air) in and out of the lungs Egan’s 225). If a patient lungs sounds are normal, the respiratory care practitioner is not concerned due to decrease in obstruction in the airway. Contrary, if the respiratory care practitioner listens to sounds like wheezes, stridor, rhonchi, rales, the practitioner is mostly concerned due to the fact that an increase in obstruction is either in the upper or lower airway. This increase obstruction could lead to decrease tissue oxygenation by causing tissue hypoxia, cyanosis, stagnant or a disease such as chronic bronchitis.