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Applied physiology: respiration and oxygen therapy Molnár Zsolt Aneszteziológiai és Intenzív terápiás Intézet Szegedi Tudományegyetem Nobel prize for Vitamin C Szent-Györgyi Albert 1893-1986 Szent-Györgyi – Krebs cycle Szent-Györgyi Albert 1893-1986 Biochemistry of muscle movements Szent-Györgyi Albert 1893-1986 Anatomy, physiology - the missing link… Upper airway • The nose: • Clears • Heats (32-36) • humidifies (90%) The larynx • Which is the narrowest part? The larynx • Which is the narrowest part? • Cricoid and acute surgery The larynx • Which is the narrowest part? • Cricoid and acute surgery • Epiglottis • Tracheostomy Anatomy - thorax • Breathing • Inspiration: active • Expiration: passive • End expiratory pause • Intrapleural pressure: • Normal value: ±2-3 cmH2O • Coughing, sneezing: > 60 cmH2O • Peak inspiratory flow (PIF) • PIF at rest ~ 20-30 l/min Gas exchange • Function of breathing • Oxigenation • CO2-elimination • Acute respiratory failure • Type I: hypoxic • Type II: hypercapnic • Mixed or global Normal gas exchange SvO2 = 75% = 40 Torr 120 Torr ~ 100 Torr Molnár ‘99 Shunt Molnár ‘99 Venous admixture 120 Torr A záródási kapacitás (CC) • Normális tüdő: – CC az ERV-ben – FRC>CC • ALI/ARDS: – CC a VT-ben – FRC<CC VT ERV FRC CC CC RV Venous admixture and O2 therapy O2 180 Torr Degree of venous admixture 0 5% 10% 400 • „Iso-shunt” diagram 15% 20% 300 Nunn JF. Appl. Resp Physiol., 1993 25% 200 30% 100 50% 0,2 Molnár ‘99 0,6 FiO2 1,0 Oxygen therapy O2 therapy - indications – – – – – – – – – – – – – – Molnár ‘99 Respiratory distress (resp. rate>24/min or laboured breathing) Asthmatic attack Hypotension (RRsyst < 100 mmHg) Signs of abnormal heart function Metabolikc acidosis (act HCO3 < 18 mmol/l) Suspected AMI Severe trauma and/or severe blood loss Sepsis Altered level of consciousness Drug overdose with confusion Smoke, CO, toxic gas inhalation Complications during labour Transport of the critically ill Every postoperative condition Variable performance devices Features • Breathing cycle • Inspiration – expiration – end expiratory pause • Peak inspiratory flow (PIF): • At rest ~ 20-30 l/min • Forced inspiration >60 l/min • Variable performance devices • Fresh gas flow < PIF • Performance depends on patient’s breathing pattern • Types • Nasal specs - Face mask – Mask with reservoire balloon Molnár ‘99 O2-rotameter • 3 O2 ports/bed • Flow:0-16 L/min Molnár ‘99 Nasal specs • • • • Molnár ‘99 FiO2 ~ 30% Flow: 2-6 L/min Comfortable, cheap Dries nasal mucous tissues Face mask • • • • Increases dead space Flow: 5-10 L/min FiO2 ~ 50% Humidification unsolved Molnár ‘99 Mask with a reservoire • • • • Flow: 5-15 L/min Balloon FiO2 ~ 80% Humidification unsolved Molnár ‘99 Monitoring Pulsoximetry Pletismograph and Oximeter Molnár ‘99 The pulsoximeter • Continuous • Doesn’t replace blood gas tests Molnár ‘99 Motto First move in the care of a critically ill: Give oxygen!
