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Physiologic Changes
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Uterine enlargement and abdominal distension result in a 4- to 5-cm cephalad displacement of the diaphragm and a 5- to 7-cm increase in thoracic circumference. This results in a decrease in expiratory reserve volume, residual volume, and functional residual capacity. There is a compensatory increase in inspiratory capacity, while total lung capacity and vital capacity do not change [14]. Chest wall compliance is increased, but inspiratory muscle strength is preserved with an overall increase in the oxygen cost of breathing [14]. However, it is important to recognize that there is no significant change in the parameters of forced vital capacity, peak expiratory flow rate (PEFR), or forced expiratory volume in 1 second (FEV1) during pregnancy.
Respiratory system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
7.4. Pulmonary function tests in a child with moderately severe asthma are likely to showincreased vital capacity.increased functional residual capacity.normal timed vital capacity (FEV1).increased lung elastic recoil.increased total lung capacity.
α1-Antitrypsin deficiency
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Pulmonary disease is the most common expression of the PIZZ phenotype [29] (Figure 107.2). As many as 90 percent develop emphysema. It is classically early in onset, occurring at 20–40 years of age in smokers and 55 in nonsmokers [5, 30, 31]. It is referred to as chronic obstructive pulmonary disease or COPD. The earliest symptom is dyspnea on exertion. Cough develops in about half of the patients, and recurrent pulmonary infections are common. On examination, the patient may be thin, but the diameter of the chest is increased. Breath sounds are diminished, and the chest film reveals hyperinflation, especially in the bases. The diaphragms may be flattened. Pulmonary function tests are typical of severe emphysema consistent with a loss of pulmonary elastic recoil. Total lung capacity is impaired, as is residual volume. Air flow is limited, and diffusion capacity and maximum transpulmonary pressure are reduced. Mild hypoxemia at rest may increase with exercise. Hypocarbia and respiratory alkalosis may be associated with mild pulmonary hypertension. Electrocardiograms may show chronic strain on the right heart with right axis deviation and right atrial hypertrophy. There may be a right bundle branch block.
Rapid resolution of refractory hypoxemia and vascular spiders following liver transplantation
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Allison Love, Rachel Jen, Lindsay Van Tongeren, C. Francis Ryan
A 65-year-old man was admitted for assessment for possible lung transplantation to manage severe refractory hypoxemia, platypnea and orthodeoxia, suspected to be due to hereditary hemorrhagic telangiectasia (HHT). He had a previous diagnosis of mild unclassifiable interstitial lung disease based on findings on chest CT imaging and review at multidisciplinary interstitial lung disease rounds. He also had mild centrilobular and paraseptal emphysema. He had a 45-pack-year smoking history prior to quitting 10 years previously. Pulmonary function testing showed forced vital capacity (FVC) 5.54 L (112% predicted), forced expiratory volume in 1 second (FEV1) 4.10 L (104% predicted), post-bronchodilator FEV1/FVC 0.74 with no significant bronchodilator response, and normal flow-volume loop. Lung volumes were normal with total lung capacity of 105% predicted and residual volume of 102% predicted. Diffusing capacity of lung for carbon monoxide (DLCO) was 64% predicted.
Myofascial release in patients during the early postoperative period after revascularisation of coronary arteries
Published in Disability and Rehabilitation, 2020
Maria Ratajska, Małgorzata Chochowska, Anita Kulik, Paweł Bugajski
In patients with postoperative pulmonary dysfunction, an increased respiratory frequency is observed along with shallower breathing, inefficient coughing and hypoxemia [8]. Moreover, there may be a decrease in the vital capacity (VC), forced vital capacity (FVC), one-second forced expiratory volume (FEV1), FEV1/FVC, peak expiratory flow (PEF), inspiratory capacity (IC), functional residual capacity (FRC), residual volume (RV) and total lung capacity (TLC) [9–11]. Lower spirometry results may persist even up to 4-6 months post-surgery [12,13] and one study has shown that they may still be present even one year post-surgery [10]. Additionally, patients may develop impairments in gas exchange, which cause a decrease in the oxygen partial pressure (PaO2) and an increase in the carbon dioxide partial pressure (PaCO2) in arterial blood [14]. Surgical disruptions of the richly vascularised and innervated pleura and chest wall are the causes of severe pain after sternotomy, which further weakens the respiratory muscles, restricts the chest, glenohumeral joint and spine mobility, as well as impedes the expectoration of the secretion [5,15,16]. The aforementioned factors as well as the patients’ fear of pain, the diastasis of the sternum and the postoperative wound [17] all contribute to the further deterioration of pulmonary function.
Change of position from a supine to a sitting position increases pulmonary function early after cardiac surgery
Published in European Journal of Physiotherapy, 2020
Annette Fjerbaek, Elisabeth Westerdahl, Jan J Andreasen, Lars P. Thomsen, Barbara C. Brocki
The rationale for early post-operative mobilisation in relation to pulmonary function is that an upright position augments Vt and IC when compared to the supine position in bed. This increase in Vt and IC is supposed to enhance alveolar ventilation, which may, in turn, contribute to reversing the negative effects of surgery on pulmonary function. This rationale is not yet sufficiently supported by evidence in patients after cardiac surgery and, to the best of our knowledge, changes in Vt from supine to sitting position after cardiac surgery have not previously been described. Our findings of an increase in Vt and IC expand the results reported by Jenkins et al. [14] on an increase in FRC, total lung capacity (TLC) and vital capacity (VC) patients from supine to sitting position after CABG.