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CO Diffusion

Deleted user 13 questions Updated 25 Aug 2016

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  1. 1Measures how well [blank_start]CO[blank_end] can diffuse across the [blank_start]alveolar[blank_end] capillary membrane

    Measure in mlCO/min/mmHg at STPD (O celcius, 760 mmHg, dry)

    Normal value = [blank_start]25[blank_end] mLCO/min/mmHg STPD
    1. A25
    2. BCO
    3. Calveolar
  2. 2Factors that affect DLCO:
    1. Hb / Hct - DLCO will [blank_start]follow[blank_end] these values, more or less sites available for binding.
    2. Alveolar PCO2 - [blank_start]increase[blank_end] in OCO2 will [blank_start]decrease[blank_end] DLCO because PaO2 will be decreased
    3. COHb - [blank_start]Increased[blank_end] COHb will [blank_start]decrease[blank_end] DLCO because of back pressure proportionally.
    4. Pulminary Capillary Blood Volume - Increase Blood Volume will [blank_start]increase[blank_end] DLCO because of higher Hb volume
    5. Body position - Supine will increase DLCO because of [blank_start]increased[blank_end] capillary flow
    6. Altitude - [blank_start]Increased[blank_end] altitude will [blank_start]increase[blank_end] DLCO because of decreased PaO2
    7. Breath Hold Time - Depending on how time is measured, it can increase or decrease DLCO
    8. Washout Volume - Volume discarded prior to collecting alveolar sample. is usually 1 liter or less.
    9. Alveolar Sampling Technique - Normally .5 - 1 L is collected.
    1. Afollow
    2. Bincrease
    3. Cdecrease
    4. DIncreased
    5. Edecrease
    6. Fincrease
    7. Gincreased
    8. HIncreased
    9. Iincrease
  3. 3Other DLCO Considerations
    No [blank_start]smoking[blank_end] for 48 hrs before the test and avoid heavy [blank_start]exertion[blank_end].
    DLCO = [blank_start]VCO/PACO[blank_end] = (mL of CO diffusion per min) / (Alveolar Partial Pressure of CO)
    DLCO will increase 2-3 times during [blank_start]exercise[blank_end]
    DLCO will [blank_start]decrease[blank_end] with restrictive disease with loss of lung volume. (Pulmonary fibrosis, Sarcoidosis)
    Emphysema will decrease DLCO because of loss [blank_start]surface area[blank_end]. VQ mismatch and increase distance from terminal bronchiole to AC membrane.
    1. Asmoking
    2. Bexertion
    3. CVCO/PACO
    4. Dexercise
    5. Edecrease
    6. Fsurface area
  4. 4DLCO Troubleshooting
    1. A [blank_start]leak[blank_end] will decrease DLCO
    2. Unidirectional valves must have [blank_start]low[blank_end] deadspace, low [blank_start]resistance[blank_end], be easy to [blank_start]maintain[blank_end] to prevent leaks/resistance.
    3. [blank_start]Polycythemia[blank_end] will increase DLCO to over 100%
    1. Aleak
    2. Blow
    3. Cresistance
    4. Dmaintain
    5. EPolycythemia
  5. 5DLCO SB Technique
    1. Pt exhales to RV then quickly inhales to TLC a mix of [blank_start].3[blank_end]% CO, [blank_start]10%[blank_end] He, [blank_start]21[blank_end]% O2, and [blank_start]N2[blank_end]. Volume must be [blank_start]85[blank_end]% of VC. Pt Hold breath for [blank_start]8[blank_end]-[blank_start]12[blank_end] seconds then exhales quickly.
    [blank_start]He[blank_end] corrects for CO trapped in [blank_start]RV[blank_end] and is a [blank_start]carrier[blank_end] gas for CO.
    1st portion (washout vol) exhaled is discarded (.75 - 1 L, decrease to .5 L if FVC is less than 2L)
    Next .5 - 1 L is collected (end tidal or alveolar sample)
    Data collected: [blank_start]Fi[blank_end]CO, [blank_start]Fe[blank_end]CO (infrared analyzer), [blank_start]Fi[blank_end]He, [blank_start]Fe[blank_end]He (He analyzer), [blank_start]Inspired[blank_end] and [blank_start]Alveolar[blank_end] volume (Vi, VA) with pneumotach, and [blank_start]breath hold[blank_end] time.
    [blank_start]CO[blank_end] and [blank_start]He[blank_end] concentrations are used to calculate DLCO (initial CO is .3%)
    Most [blank_start]common[blank_end] Method. Is fast, easy and simple to calculate
    1. A.3
    2. B10%
    3. C21
    4. DN2
    5. E85
    6. F8
    7. G12
    8. HHe
    9. IRV
    10. Jcarrier
    11. KFi
    12. LFe
    13. MFi
    14. NFe
    15. OInspired
    16. PAlveolar
    17. Qbreath hold
    18. RCO
    19. SHe
    20. Tcommon
  6. 6DLCO Single Breath QA
    Pt should be seated for [blank_start]5[blank_end] minutes before testing and O2 not administered for [blank_start]5[blank_end] minutes before testing
    Inspired volume should be >[blank_start]85[blank_end]% of SVC
    Inhalation in [blank_start]2.5[blank_end] - [blank_start]4[blank_end] seconds
    Exhalation should occur in [blank_start]2.5[blank_end] - [blank_start]4[blank_end] seconds
    Breath hold time should be [blank_start]10[blank_end] seconds
    Acceptable efforts within [blank_start]10[blank_end]% of each other.
    Report [blank_start]mean[blank_end] of [blank_start]2[blank_end] acceptable maneuvers.
    Wait 4 minutes in between
    Washout volume is [blank_start].75[blank_end] to 1 liter
    Sample collection is [blank_start].5[blank_end] - 1 liter
    1. A5
    2. B5
    3. C85
    4. D2.5
    5. E4
    6. F2.5
    7. G4
    8. H10
    9. I10
    10. Jmean
    11. K2
    12. L.75
    13. M.5
  7. 7Steady State CO Diffusion (DLCO SS1 - Filey Method):
    Pt breathes mix of [blank_start].1[blank_end] - [blank_start].2[blank_end]% CO in RA for 5-6 minutes to achieve a steady state.
    During final [blank_start]2[blank_end] minutes, exhaled gas is collected in neoprene balloon and [blank_start]ABG[blank_end] is drawn.
    Data measured - [blank_start]Fi[blank_end]CO, [blank_start]Fe[blank_end]CO (infrared analyzer), [blank_start]Fi[blank_end]N2, [blank_start]Fe[blank_end]N2 (N2 analyzer), [blank_start]Exhaled[blank_end] Volume (pneumotach), [blank_start]Pe[blank_end]CO2 (infrared analyzer), [blank_start]Arterial[blank_end] CO2 (severinghaus electrode), [blank_start]Fi[blank_end]O2, [blank_start]Fe[blank_end]O2, mass spec / fuel cell.
    Simple - can be used for [blank_start]exercise[blank_end] stress testing. Pts with difficulty following instructions or inspiratory obstruction.
    [blank_start]Pe[blank_end]CO2 and [blank_start]Pa[blank_end]CO2 required for calculation of PACO.
    1. A.1
    2. B.2
    3. C2
    4. DABG
    5. EFi
    6. FFe
    7. GFi
    8. HFe
    9. IExhaled
    10. JPe
    11. KArterial
    12. LFi
    13. MFe
    14. Nexercise
    15. OPe
    16. PPa
  8. 8End Tidal CO Diffusion (DLCO SS2):
    Same as DLCO [blank_start]SS1[blank_end] except the PACO is measured by taking the average [blank_start]PetCO[blank_end] from breath by breath analysis with infrared analyzer.
    End tidal PetCO is assumed to equal [blank_start]PACO[blank_end] used to calculated DLCO
    1. ASS1
    2. BPetCO
    3. CPACO
  9. 9Assumed VD CO Diffusion (DLCO SS3)
    Similar to SS1 except FACO is calculated by a formula that assume [blank_start]VD[blank_end] to be 1 mL per lb of body weight

    Calculated FACO is used to derive [blank_start]PACO[blank_end] for DLCO calculation
    1. AVD
    2. BPACO
  10. 10Mixed Venous PCO2 Co Diffusion (DLCO SS4):
    VCO measured using same method as [blank_start]SS1[blank_end]
    [blank_start]PACO[blank_end] calculated by estimating mixed venous CO2 partial pressure from an [blank_start]equilibration[blank_end] technique
    AVoids [blank_start]blood[blank_end] draw
    1. ASS1
    2. BPACO
    3. Cequilibration
    4. Dblood

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Description
User has deleted their subject information Quiz on CO Diffusion, created by Deleted user on 19/08/2016.
Author
Deleted user
Language
English
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History
Created on 19 Aug 2016 · updated on 25 Aug 2016

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