One lung ventilation

Pregunta	Respuesta
V/Q ratio in upper lobe	3.4 Ventilation>>>perfusion PA>Pa>Pv
V/Q ratio in middle lobe	0.8- average Ventilation = perfusion Pa>PA>PV
V/Q in lower lobe	0.63 perfusion>>> ventilation Pa>PV>PA
What can cause hypoxic pulmonary vasoconstriction	general anesthesia Lung injury/contusion systemic vasodilators (nitride/prostacyclin)
Lungs response to increase in CO2	Hypoxic pulmonary vasoconstriction vasoconstricts to shunt blood to unaffected side
Pulmonary vasoconstriction results in	decreasing blood supply-pushing blood to dependent lung
Effect of PEEP on lung shunting	Shunts blood to non-dependent lung i
Continuous CPAP	Decreases shunting
Lung isolation options	single lumen ET tube Double lumen ET tube Bronchial blockers Univent ET tube
distance from mouth to carinia	15 cm
distance from carinia to right main stem	12 cm
Distance from right main stem to secondary bronchiols	1.5-2 cm
Distance from left pain stem to secondary bronchiols	4.5-5
Double lumen ET size	Female: 35-37 Male: 37-39 measure Left Bronchus width (Xray)= tracheal with
Types of Double Lumen ET	Carlen White Robertshaw
Insertion of Double lumen	distal curved anterior Rotate 90 degrees counter clock and advance until resistance is met
Cuff inflation of double lumen	Tracheal cuff: 5-10 cc Bronchial cuff: 1-2 cc
Advantages of DL tube	best for absolute lung separation ability to suction Conversion from one lung to two lung vent with ease
Disadvantage of DL	selection of tube size tears in tracheal cuff during extubation tracheobronchial rupture
Complications of DLT	hypoxia (d/t malplacement or occlusion) Traumatic laryngitis Tracheobronchial rupture Suturing tube to bronchous during sx
Bronchial blocker advantages	easy recognition of anatomy good for difficult airways not cuff damage during intubation no need to replace ET tube if pt remains intubated
Bronchial blocker disadvantage	small suction channel conversion to one lung ventilation high maintenance device-dislodge easy
complications of bronchial blockers	severe hypoxia inclusion of BB in suture line lung rupture malposition and dislogment
Univent tubes advantage	single lumen with channel for BB Difficult airways Easy passage during awake intubation selective lobar blocker increase oxygenation easy conversion to ETT w/o tube exchange
Tidal volumes	5-6 ml/kg + 5 PEEP < 8= atelectasis 10-12 ml/kg >15 ml increase shunting
Lung down recruitment strategies	Pressure control Sustained breath (PAW 30-40)-30-60 sec 100% O2

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	Creado por Carly Pruemer hace alrededor de 6 años