6. Respiratory Monitoring and Instrumentation
In the assessment of a disease or an anesthetic regimen, respiratory monitoring plays an essential role. It adds to the clinical evaluation by the anesthesiologist and helps with the risk stratification of the disease or assessment of the response to treatment. In the case of a mechanically ventilated patient during anesthesia or in the ICU, monitoring of respiratory function helps with better adjustment of the ventilator parameters, with the aim of maintaining the homeostasis, therefore sustaining stable physiological conditions indispensable for survival, while minimizing complications.
The American Society of Anesthesia (ASA) Standards for Basic Anesthetic Monitoring1 and the Practice Guidelines
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In order to assess the respiratory mechanics and maintain homeostasis, pressure monitoring is fundamental. The most accessible pressure for the anesthesiologist is the airway pressure during controlled mechanical ventilation, whether it is volume control or pressure control ventilation. Often, volume control ventilation is established: the inspiratory gas flow is constant and the end-expiratory airway pressure (PEEP) has to be adjusted. The airway pressure during controlled mechanical ventilation is the pressure transduced at the anesthesia machine. Inspiratory airway pressure will result as a combination of tidal volume and the lung compliance, gas flow and airway and anesthesia circuit …show more content…
Lung function tests are not routinely recommended as part of the preoperative assessment, but expert senior anesthesiologists strongly agree that in ASA 3 and 4 patients with respiratory comorbidities, undergoing major and complex surgeries, lung function tests should be performed8,9. These guidelines do not apply to patients undergoing thoracic surgery, where patients routinely have a spirometry as part of preoperative diagnostic and surgical
This essay describes how the anaesthetic machine and airway management equipment are prepared in operating theatres and discusses how they are ensured safe for use. It evaluates the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines related to safe practice and the preparation of the ET tubes, laryngeal masks, guedels, Naso pharyngeal airways and the laryngoscope. The function of the anaesthetic workstation is to deliver a mixture of anaesthetic agents and gases safely to the patient during the induction process and throughout surgery. In addition, it also provides ventilation to support breathing and monitors the patient’s vital signs to minimise the anaesthetic risks to the patient whilst in the care of health professionals. The pre-use check is vital to patient safety as an inadequate check of the anaesthetic machine or airway management equipment can and does lead to significant harm of the patient including mortality (Medicines and Healthcare Products Regulatory Agency (MHRA), 2008 and Magee, 2012).
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
Previous research used noninvasive ventilation to help those with COPD improve their altered level of consciousness by allowing the alveoli to be ventilated and move the trapped carbon dioxide out of the lungs. When too much carbon dioxide is in the blood, the gas moves through the blood-brain barrier and causes acidosis within the body, because not enough carbon dioxide is being blown off through ventilation. The BiPAP machine allows positive pressure to enter the lungs, expand all the way to the alveoli, and create the movement of air and blood. Within the study, two different machines were used: a regular BiPAP ventilator and a bilevel positive airway pressure – spontaneous/timed with average volume assured pressure support, or AVAPS. The latter machine uses a setting for a set tidal volume and adjusts based on inspiration pressure.
Breathing is the most important AL (Roper et al, 1998). A detailed assessment of her airway would be performed because protection of the airway throughout anaesthesia is essential (Yates, 2000). This does not just include recording of respiration rate and oxygen saturation (SpO2) but also noting any use of accessory muscles, shortness of breath, auscultation of chest and lungs areas for wheezes/crackles and asking patient about history of any respiratory illness/smoking (McArthur-Rouse, 2007).
John B. Pollard, Ann L. Zboray, Richard I Mazze. The International Anesthesia Research Society. (1996).
The ability to carry out and document a full respiratory and cardiovascular assessment is an essential skill. The severity of illness can be initially evaluated by inspection, palpation, percussion, and auscultation. During analysis, specific locations of symptoms can be identified using landmarks such as the midaxiallary, midclavicular, and, the midsternal line. Indicate anterior or posterior thorax, and use the midaxillary line location when applicable (Bickley & Szilagyi, 2013).
Caring for people is my passion. My senior year of high school is when I witnessed my grandmother live on a ventilator for about a week. It awakened a new level of passion in me to care for people with cardiopulmonary problems. The Respiratory Therapy Care profession has intrigued me with how they improve the quality of life in their patients. I will enjoy working closely with patients in addition to working high tech equipment. By entering into this program and graduating out of this program I know that this will satisfy my personal goals for the next five years in many ways. The continues challenges of trying to figure out what’s wrong the heart that day or what’s wrong with the lung the next day will always keep me on my toes. It will always
Porhomayon, J., P. Papadakos, and ND Nader. "Alteration in Respiratory Physiology in Obesity for Anesthesia-critical Care Physician." HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 3.2 (2011): 109-18. Web.
“Technological advancements in anesthesia practice: Role of decision support system.” Anesthesia: Essays and Researches. January 8, 2014. Web. October 23, 2015. There have been many advancements in technology in the anesthesia field. A recent major advancement has been the decision support system (DSS). The decision support system acts similar to a second human central nervous system, and receives as well as relays information to and from the patient and the anesthesia information management system (AIMS). The DSS helps to maintain the data coming into and out of the patient during a medical procedure. The DSS also provides help during a medical crisis, giving the physicians a solution if an intra-operation (during the operation) crisis happens. The DSS can also design various scenarios for pre, intra, and post operation scenarios for the anesthesiologist to prepare for based on that patient’s medical history, information, and
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
Anesthesiologists have many responsibilities. 3They measure the patient’s temperature, pulse, heart rate, and breathing rate while under the sedative. They have...
Webster CS, Merry AF, Larsson L, McGrath KA, Weller J. The frequency and nature of drug administration error during anaesthesia. Anaesth Intensive Care 2001; 29: 494-500.
Hinkle, Janice, and Kerry Cheever. “Management of Patients with Chronic Pulmonary Disease." Textbook of Medical-Surgical Nursing, 13th Ed. Philadelphia: Lisa McAllister, 2013. 619-630. Print.
There are 2 types of breathing, costal and diaphragmatic breathing (Berman, 2015). Costal refers to the intercostal and accessory muscles while diaphragmatic refers to breathing using your diaphragm (Berman, 2015).It is important to understand the two different types of breathing because it is vital in the assessment of the patient. For example, if a patient is suing their accessory muscles to aid in breathing then we can safely assume that they are having breathing problems and use a focused assessment of their respiration. Assessing respiration is fairly straightforward. The patient’s respiration rate can be affected by anxiety so a useful to avoid this is to check pulse first and after you have finished that, while still holding their pulse point, check their respiration rate. Inconspicuous assessment avoids the patient changing their breathing because they know they are being assessed which patients can sometimes do subconsciously. Through textbooks and practical classes I have learned what to be aware of while assessing a patient’s respiratory rate. For example; their normal breathing pattern, if and how their health problems are affecting their breathing, any medications that could affect their respiratory rate and also the rate, depth, rhythm and quality of their breathing (Berman, 2015). The only problem I found while assessing respiration rate was I thought it seemed a bit invasive looking at the
The roles of the circulatory and respiratory system both carry important responsibilities and are essential in their jobs to the human body. The circulatory system is one, if not the, most important system in the human body. The circulatory system is made up of the heart, blood, and blood vessels. Within the blood vessels, there are three types: arteries, veins, and capillaries. The heart is an organ made up of cardiac muscle that has a role similar to a pump. When the muscles in the heart contract, it pumps fresh blood away from the heart, through a main artery called the aorta, and to the organs and cells of the body. Nutrients and oxygen then enter the cells through diffusion of the tissues. The respiratory system transports oxygen to the circulatory system. When transporting oxygen to the circulatory system, this will in turn transport oxygen to the rest of the cells in the body. Aside from transporting oxygen to the body, the respiratory system also plays a role in the removal of carbon dioxide and other contaminants in the body. These two systems effectively and efficiently work together in order to supply the body with oxygen and remove carbon dioxide and any other