5. Functions of the Conducting Zone
1. Provides a low-resistance pathway for air flow; resistance is physiologically regulated by changes in contraction of airway smooth muscle and by physical forces acting upon the airways.
2. Defends against microbes, toxic chemicals, and other foreign matter, cilia, mucus, and phagocytes perform this function.
3. Warms and moistens the air.
4. Phonates (vocal cords).

9. ALVEOLAR VENTILATION
Alveolar ventilation is defined as the volume of atmospheric air entering alveoli each minute.
Minute ventilation is the total ventilation per minute.

10. Regulation of Respiration
Respiratory Center
Dorsal respiratory group of neurons - its inspiratory and rhythmical
function
Pneumotaxic center limits the duration of inspiration and increases the
respiratory rate
Ventral respiratory group of neurons - functions in both inspiration and
expiration
Possibility of an “Apneustic Center” in the lower pons
Lung inflation signals limit inspiration - The Herring-Breuer Inflation
Reflex
Control of Overall respiratory Center Activity

11. . Pathophysiologic Causes of Hypoxemia Effect on P(A-a)O2 Gradient
Respiratory
Diffusion impairment (edema, fibrosis) Increased
Physiologic shunt Increased
Generalized hypoventilation (emplysema) Normal
Local low VA/Q (depressed respiration) Increased
Nonrespiratory
Intracardiac right-to-left shunt Increased
Decreased PIO2, low PB, low FIO2 Normal
Reduced oxygen content (anemia and carbon
monoxide poisoning) Normal .
CO2 20 X O2
PVO = 40 mmHg
PAO = 104 mmHg
PVCO = 47 mmHg
PACO = 40 mmHg 2
64 mmHg 2 2
7 mmHg 2

12. Manifestations of Respiratory Distress
Altered mental status
Increased work of breathing
Tachypnea
Accessory muscle use, retractions, paradoxical breathing pattern
Catecholamine release
Tachycardia, diaphoresis, hypertension
Abnormal arterial blood gas values

13. Acute Respiratory Failure Management
Oxygen supplementation
Increase FIO2
Match flow between delivery device and inspiratory demand
High- vs. low-oxygen systems
High- vs. low-flow systems

14. Orotracheal Intubation – Preparation
Appropriate monitoring – oximetry, ECG, BP
Assemble equipment
Laryngoscope – test light, select blade
Endotracheal tube – test cuff, lubricate
Stylet – insert, angulate
Suction – test
Magill forceps

15. Orotracheal Intubation – Preparation
Don protective garb
Elevate occiput with pad if no cervical spine injury suspected
Provide anesthesia, sedation, amnesia, and neuromuscular blockade as required

16. Orotracheal Intubation – Technique
Proper operator position
Holding the laryngoscope handle
Application of cricoid pressure
Mouth opening methods

17. Orotracheal Intubation – Technique
Insertion of laryngoscope blade – tongue control
Tongue displacement medially – visualize epiglottis

18. Orotracheal Intubation – Technique
Advance laryngoscope into position (vallecula for curved blade; under epiglottis for straight blade)
Elevate base of tongue and expose glottic opening

19. Orotracheal Intubation – Technique
Elevate base of tongue further to fully expose glottic opening and surrounding anatomy

20. Orotracheal Intubation – Technique
Insert endotracheal tube under direct vision to 23–25 cm at lip
Remove stylet and laryngoscope, inflate tube cuff
Confirm tube position – breath sounds, CO2 detector
Secure endotracheal tube
Obtain chest radiograph

21. Orotracheal Intubation – Technique
Straight blade position, elevating the epiglottis
Be aware of laryngospasm when epiglottis is touched

24. Traqueostomias

25. Traqueostomias

26. Traqueostomias

27. Traqueostomias

28. Traqueostomias

29. Traqueostomias

30. Traqueostomias

31. Traqueostomias Cuidados RX tórax Pressão balonete Sangramento
Secreções
Nebulização
Hidratação
Troca

32. Traqueostomias
Complicações
Per-operatórias
Precoces
Tardias

33. Traqueostomias Per-operatórias Sangramento Lesão nervosa
Lesão tireóide
Lesão parede posterior traquéia
Colocação cânula posição inadequada
Arritmias

34. Traqueostomias Precoces Pneumomediastino Pneumotórax Embolia gasosa
Fístula tráqueo-esofágica

35. Traqueostomias Tardias Infecção Sangramento Obstrução cânula
Fístula tráqueo-esofágica
Fístula tráqueo-cutânea
Cicatriz hipertrófica
Traqueomalácia
Estenose traquéia