Respiratory

Aspiration Risk Factors

emergency surgery, increased gastric pressure, decreased LES tone, blunted airway protective reflexes, full stomach, pregnancy, bowel obstruction, obesity, GI motility disorders, neurologic conditions, inadequate NPO time, inadequate depth of anesthesia, laparoscopy, and bowel surgery

Aspiration Effects

atelectasis, pneumonitis, pneumonia

Aspiration Degree of Lung Injury

pH (<2.5) and volume (>25 mL)

Aspiration Management

sit up or recover position, suction, avoid NIV, CXR, bronchoscopy, no steroids or abx, close monitoring, zosyn if worsens

Aspiration Prevention

fasting, antiemetics, RSI (+/- cricoid), limited tidal volumes, extubation after return of airway reflexes

Predictors of Post-Op Respiratory Failure

high ASA, poor functional status, hypoalbuminemia, lung disease, liver cirrhosis, CHF, CKD/SRD, emergency surgery, long procedure, large volume fluid/blood resuscitation, thoracoabdominal surgeries

Prevent Post-Op Respiratory Failure

low tidal volumes, use of PEEP

Pathogenesis Post-Op Respiratory Failure

pain, laying flat, anesthetics, impaired secretion clearance, high FiO2 (absorption atelectasis), bronchospasm, residual NMB, shock, acidosis, fluid overload worsen gas exchange, increase burden on resp system (debility, malnutrition, lung disease)

Diagnosis Post-Op Respiratory Failure

history, physical, intraop record, ABG, CBC, coags, CXR, lung US, echo, CTP, sputum cultures

Indications NIPPV

acute cardiogenic pulmonary edema, OSA, COPD exacerbation

Indications Emergency Intubation

hypoxia, hypercapnia, encephalopathy, shock, excessive work of breathing, airway obstruction, neuromuscular weakness

Berlin Definition

1. new or worsening respiratory symptoms within one week of clinical insult2. bilateral radiographic opacities not fully explained by effusions, lobar/lung collapse, or nodules3. symptoms not fully explained by cardiac failure or fluid overload4. severity based on PaO2/FiO2 while on PEEP 5 cm H2O (mild 200-300, moderate 100-200, severe <200)

Pathophysiology of ARDS

alveolar fluid, epithelial dysfunction, pulmonary edema, depletion of surfactant, immune response, inflammation

RSBI

tidal volume / RR <105