DOCSLIB.ORG

Andrea Kline Tilford Phd, CPNP‐AC/PC, FCCM

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Andrea Kline Tilford Phd, CPNP‐AC/PC, FCCM Acute Care Pediatric Nurse Practitioner Review Course 2020 Andrea Kline Tilford PhD, CPNP‐AC/PC, FCCM C.S. Mott Children’s Hospital Ann Arbor, Michigan ©202 0 Disclosures • I have no financial relationships to disclose • I will not discuss investigational drug use ©202 0 Objectives • Discuss general principles of pediatric respiratory physiology • Discuss the presentation and evaluation of common pediatric respiratory diseases • Identify appropriate management strategies for common pediatric respiratory diseases ©202 0 Basic Anatomy • Upper Airway • Supraglottic (nose, nasopharynx, epiglottis) • Glottis (vocal cords, subglottic area, cervical trachea) • Humidifies inhaled gases • Warms inhaled gas • Site of most resistance to airflow • Conducting airways (dead space) • Lower airways • Thoracic trachea, bronchi, bronchioles and alveoli (gas exchange) ©202 0 Anatomical Considerations in Children • Pediatrics • Small mouth • Large tongue • In relation to mandible • Floppy epiglottis (infants) • Large occiput • Infants are obligate nose breathers (until ~ 6 months of age) • Cricoid ring narrowest portion of airway in infants and young children ©202 0 Bronchus • Bifurcates into right and left bronchus • RIGHT side generally more straight and more likely to be site of aspiration www.med.umich.edu ©202 0 Alveoli • Continue to multiply until ~ 8 years of age Covered in capillaries Site of gas exchange oac.med.jhmi.edu ©202 0 Basic Physiology • Goal of respiration = Oxygen in and carbon dioxide out • Oxygen ʻinʼ • For cell use • Carbon dioxide ʻoutʼ • Produced by cells ©202 0 Gas Exchange • Inhalation • Active; requires contraction of several muscles (e.g. diaphragm, intercostals) • Exhalation • Passive • Relaxation of intercostals and diaphragm, return of rib cage, diaphragm, and sternum to resting position, increases pressure in lungs and air is exhaled **PEARL: Some conditions, such as status asthmaticus, interfere with passive exhalation. Physical exam demonstrates forced and prolonged exhalation phase. ©202 0 Impairment of Respiration • Under neural and chemical control • Hypoventilation should always raise concern for neuronal anomaly (e.g. drug effect, underlying intracranial process, others) • Hyperventilation often caused by conditions outside the lung (metabolic acidosis, neurologic process, anxiety) ©202 0 COMMON PEDIATRIC RESPIRATORY DISEASES ©202 0 Bronchiolitis • Definition • Acute inflammatory disease of the lower respiratory tract • Etiology • Many different viral agents • Respiratory syncytial virus (RSV) and influenza account for most cases when a specific agent can be identified • Other common agents: Rhinovirus, adenovirus, parainfluenza, human metapneumovirus • Incidence • Peaks in winter months, though common fall – spring • Risk Factors for severe disease • Prematurity, cardiopulmonary disease, infants < 6 months of age, immunodeficiency www.nlm.nih.gov ©202 0 Bronchiolitis • Pathophysiology • Inflammatory disease of lower respiratory tract • Also, a disease of lung parenchyma • Clinical Manifestations • Rhinorrhea, congestion • Tachypnea, increased work of breathing • Hypoxia Flat diaphragms • Fever • Wheezing; prolonged exhalation • *Typically begins as upper respiratory infection that spreads to lower airways in first few days of illness • Diagnostic Evaluation • History and physical; diagnostic in most cases • Chest radiograph (Commonly demonstrates hyperexpansion, patchy atelectasis, peribronchial thickening) • Viral studies are supportive (RSV, influenza, etc) • Pulse oximetry www.surgery.usc.edu Bronchiolitis Chest Xray Peribronchial Bronchial wall thickening thickening www.learningradiology.com ©202 0 Bronchiolitis • Management • Supportive care • Oxygen • Additional respiratory maneuvers, if indicated • Routine use of bronchodilators, racemic epinephrine, and corticosteroids are NOT recommended; AAP guidelines • Prevention • Hand washing • Palivizumab®, as indicated http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2014-2742 ©202 0 Laryngotracheobronchitis (Croup) • Definition • Infection involving subglottic airway, larynx, trachea, and bronchi • Etiology • Most commonly caused by parainfluenza type 1 and 2 • Less commonly caused by respiratory syncytial virus (RSV), adenovirus, influenza types A and B, parainfluenza type 3 • Infrequently caused by Mycoplasma pneumoniae • Incidence • Most commonly affects children 3 months ‐ 5 years of age • Some children are at risk for recurrent episodes • Northern hemisphere; most common between October and March ©202 0 Croup • Pathophysiology • Mucosal airway edema from infectious etiology • Subsequent epithelial necrosis • Decreased airway diameter and increased resistance to airflow • Clinical Manifestations • ʻBarkyʼcough • Stridor • Hoarseness • Increased work of breathing • Wheezing/prolonged expiratory phase • Frequently begins 12‐ 48 hours after non‐specific upper respiratory tract symptoms • Typically, symptoms are worse at night ©202 0 Croup • Evaluation • Westley Croup score or other scoring tool may be used • Stridor, retractions, air entry, cyanosis, level of consciousness • Diagnosis • Generally based on history and examination • Viral studies may be sent to identify the pathogen • Consider lateral neck films (e.g. “Steeple sign”) • Consider chest radiograph; may be obtained to evaluate for superimposed bacterial infection and/or narrowing of subglottic area ©202 0 Croup •Management • Humidified or cool mist air/gas • Steroids • Dexamethasone 0.6 mg/kg IV/IM • Oxygen and respiratory maneuvers, as needed • Consider aerosolized racemic epinephrine • Consider heliox (light gas, improves laminar flow) • Intravenous fluids, if dehydrated • Otolaryngology consult if no improvement with standard therapy ©202 0 Asthma Definition • Asthma • Chronic reversible disorder resulting in inflammation, bronchoconstriction, airway hyperresponsiveness • Characterized by episodes of cough, wheeze, dyspnea, chest tightness • Status Asthmaticus • Progressively worsening bronchospasm/airflow obstruction unresponsive to standard therapy Incidence • Most common chronic illness in childhood Etiology • Triggers • Extrinsic: Allergic/immunologic factors • Intrinsic: Infectious • Exercise induced www.uhn.ca ©202 0 Asthma • Severity Classification • Intermittent, mild persistent, moderate persistent, severe persistent • See National Heart, Lung, Blood Institute Guidelines for more information and the ʻGuidelines for the Diagnosis and Management of Asthmaʼ at: http://www.nhlbi.nih.gov/guidelines/asthma/ ©202 0 Status Asthmaticus • Symptoms • Cough, especially at night • Tachypnea • Shortness of breath • Wheezing, forced and prolonged expiratory phase • Accessory muscle use • Tachycardia • Hypoxia • Pulsus paradoxus (moderate/severe exacerbations) • *Fever, if associated with infectious trigger • Diagnosis • History and physical exam • Chest radiograph: Hyperinflation, flattened diaphragms, peribronchial thickening, narrowed cardiac silhouette • Additional studies (e.g. arterial blood gas, lactate, electrolytes may be helpful in moderate/severe cases) www.pedsccm.wustl.edu ©202 0 Pulsus Paradoxus ©202 0 Status Asthmaticus • When following arterial blood gases or other carbon dioxide measurements, anticipate hypocarbia when compensating well for exacerbation • A normal or rising carbon dioxide measurement is worrisome ©202 0 Status Asthmaticus Hyperinflation, narrowed cardiac silhouette ©202 0 Status Asthmaticus Management • Inhaled Beta2 agonists (albuterol, levalbuterol) • Bronchial smooth muscle relaxation • Reduce antigen induced histamine release • Increase mucociliary transport • Intermittent dosing (MDI or nebulized); typically every 20 minutes for one hour. Continuous for refractory exacerbation • Corticosteroids • Decreases inflammation associated with chronic and acute airway inflammation • May be given intravenously or enterally • 2‐4 hours to take effect • Therapy > 5‐7 days requires taper ©202 0 Status Asthmaticus Management – Continued •Anticholinergics (e.g. ipratropium bromide) • Promotes bronchodilation • Used most frequently in the Emergency Department to prevent hospitalization •Admission criteria • Symptoms after observation for 60 minutes • Oxygen requirement • Short acting beta agonists > every 2‐3 hours • Prior intensive care unit admissions ©202 0 Status Asthmaticus Adjunctive Therapies • Magnesium sulfate • Physiologic calcium antagonist; causes smooth muscle relaxation • May be administered continuously or intermittently, IV • Most common adverse reaction is hypotension • Intravenous beta agonist (e.g Terbutaline) • Bolus, +/‐ continuous infusion • ECG monitoring • Methylxanthines (e.g aminophylline, theophylline) • Promotes smooth muscle relaxation through unknown mechanism • Narrow therapeutic index; requires serum drug level monitoring • High side effect profile (nausea, vomiting, seizures, abdominal discomfort) ©202 0 Status Asthmaticus Adjunctive Therapies ‐ Continued •Non‐Invasive ventilation •Heliox • Low density gas • Promotes laminar flow • Facilitates delivery of oxygen and aerosolized medications Turbulent flow Laminar flow •Invasive ventilation • Use with caution Risk for air leak syndromes • Allow permissive hypercapnia • May require muscle relaxation ©202 0 PEARL: Ketamine typically used for induction in asthmatics requiring intubation due to its bronchodilatory effects. ©202 0 Pertussis Background •Commonly known as ʻwhooping coughʼ •Making a comeback; immunity does not appear to be permanent Etiology •Bordetella pertussis;
Load more

Recommended publications
  • X-Ray Interpretation
    Objectives Describe a systematic method for interpretation of chest and abdomen x-rays List findings to accurately identify common X-ray Interpretation pathology in chest & abdomen x-rays Describe a systematic method to approach the Denise Ramponi, DNP, FNP-C, ENP-BC, FAANP, FAEN important components in interpretation of upper & lower extremity x-rays Chest X-ray: Standard Views Lateral Film Postero-anterior (PA): (LAT) view can determine th On inspiration – diaphragm descends to 10 rib the anterior-posterior posteriorly structures along the axis of the body Normal LAT film Counting Ribs AP View - Portable http://www.lumen.luc.edu/lumen/MedEd/medicine/pulmonar/cxr/cxr_f.htm When the patient is unable to tolerate routine views with pts sitting or supine No participation from the patient Film is against the patient's back (supine) 1 Consolidation, Atelectasis, Chest radiograph Interstitial involvement Consolidation - any pathologic process that fills the alveoli with Left and right heart fluid, pus, blood, cells or other borders well defined substances Interstitial - involvement of the Both hemidiaphragms supporting tissue of the lung visible to midline parenchyma resulting in fine or coarse reticular opacities Right - higher Atelectasis - collapse of a part of Heart less than 50% of the lung due to a decrease in the amount of air resulting in volume diameter of the chest loss and increased density. Infiltrate, Consolidation vs. Congestive Heart Failure Atelectasis Fluid leaking into interstitium Kerley B 2 Kerley B lines Prominent interstitial markings Kerley lines Magnified CXR Cardiomyopathy & interstitial pulmonary edema Short 1-2 cm white lines at lung periphery horizontal to pleural surface Distended interlobular septa - secondary to interstitial edema.
    [Show full text]
  • Peak Flow Measure: an Index of Respiratory Function?
    International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Peak Flow Measure: An Index of Respiratory Function? D. Devadiga, Aiswarya Liz Varghese, J. Bhat, P. Baliga, J. Pahwa Department of Audiology and Speech Language Pathology, Kasturba Medical College (A Unit of Manipal University), Mangalore -575001 Corresponding Author: Aiswarya Liz Varghese Received: 06/12/2014 Revised: 26/12/2014 Accepted: 05/01/2015 ABSTRACT Aerodynamic analysis is interpreted as a reflection of the valving activity of the larynx. It involves measuring changes in air volume, flow and pressure which indicate respiratory function. These measures help in determining the important aspects of lung function. Peak expiratory flow rate is a widely used respiratory measure and is an effective measure of effort dependent airflow. Aim: The aim of the current study was to study the peak flow as an aerodynamic measure in healthy normal individuals Method: The study group was divided into two groups with n= 60(30 males and 30 females) in the age range of 18-22 years. The peak flow was measured using Aerophone II (Voice Function Analyser). The anthropometric measurements such as height, weight and Body Mass Index was calculated for all the participants. Results: The peak airflow was higher in females as compared to that of males. It was also observed that the peak air flow rate was correlating well with height and weight in males. Conclusions: Speech language pathologist should consider peak expiratory airflow, a short sharp exhalation rate as a part of routine aerodynamic evaluation which is easier as compared to the otherwise commonly used measure, the vital capacity.
    [Show full text]
  • Mantke, Peitz, Surgical Ultrasound -- Index
    419 Index A esophageal 218 Anorchidism 376 gallbladder 165 Aorta 364–366 A-mode imaging 97 gastric 220 abdominal aneurysm (AAA) AAA (abdominal aortic aneurysm) metastasis 142 20–21, 364, 366 20–21, 364, 366 pancreatic 149, 225 dissection 364, 366 Abdominal wall Adenofibroma, breast 263 perforation 366 abscess 300–301 Adenoma pseudoaneurysm 364 diagnostic evaluation 297 adrenal 214 Aortic rupture 20 hematoma 73, 300, 305 colorectal 231, 232 Aplasia, muscular 272 rectus sheath 297–300 duodenal papilla 229, 231 Appendicitis 1–4 hernia 300, 302–304 gallbladder 165 consequences for surgical indications for sonography 297 hepatic 54, 58, 141 treatment 2 seroma 298, 300, 305 multiple 141 sonographic criteria 1 trauma 297–300 parathyroid 213 Archiving 418 Abortion, tubal 30 renal 241 Arteriosclerosis 346, 348 Abscess thyroid 202–203 carotid artery 335, 337, 338 abdominal wall 300–301 Adenomyomatosis 8, 164, 165 plaque 337, 338, 345, 367, 370 causes 301 Adrenal glands 214–216 Arteriovenous (AV) malformation amebic 138 adenoma 214 139, 293, 326–329 breast 264 carcinoma 214 Artery chest wall 173, 178 cyst 214 carotid 334–339 diverticular 120, 123 hematoma 214 aneurysm 338 drainage 85–88, 93 hemorrhage 214 arteriosclerosis 335 hepatic 6, 138, 398 hyperplasia 214 plaque characteristics inflammatory bowel disease limpoma/myelipoma 214 337, 338, 345 116, 119 metastases 214 bifurcation 334, 337 intramural 5 sonographic criteria 214 bulb 339 lung 183, 186, 190 tuberculosis 214 dissection 338, 339, 346 pancreatic 11 Advanced dynamic flow (ADF) sonographic
    [Show full text]
  • Spirometry Basics
    SPIROMETRY BASICS ROSEMARY STINSON MSN, CRNP THE CHILDREN’S HOSPITAL OF PHILADELPHIA DIVISION OF ALLERGY AND IMMUNOLOGY PORTABLE COMPUTERIZED SPIROMETRY WITH BUILT IN INCENTIVES WHAT IS SPIROMETRY? Use to obtain objective measures of lung function Physiological test that measures how an individual inhales or exhales volume of air Primary signal measured–volume or flow Essentially measures airflow into and out of the lungs Invaluable screening tool for respiratory health compared to BP screening CV health Gold standard for diagnosing and measuring airway obstruction. ATS, 2005 SPIROMETRY AND ASTHMA At initial assessment After treatment initiated and symptoms and PEF have stabilized During periods of progressive or prolonged asthma control At least every 1-2 years: more frequently depending on response to therapy WHY NECESSARY? o To evaluate symptoms, signs or abnormal laboratory tests o To measure the effect of disease on pulmonary function o To screen individuals at risk of having pulmonary disease o To assess pre-operative risk o To assess prognosis o To assess health status before beginning strenuous physical activity programs ATS, 2005 SPIROMETRY VERSUS PEAK FLOW Recommended over peak flow meter measurements in clinician’s office. Variability in predicted PEF reference values. Many different brands PEF meters. Peak Flow is NOT a diagnostic tool. Helpful for monitoring control. EPR 3, 2007 WHY MEASURE? o Some patients are “poor perceivers.” o Perception of obstruction variable and spirometry reveals obstruction more severe. o Family members “underestimate” severity of symptoms. o Objective assessment of degree of airflow obstruction. o Pulmonary function measures don’t always correlate with symptoms. o Comprehensive assessment of asthma.
    [Show full text]
  • Upper Airway Obstruction in Children: Imaging Essentials
    Acute upper airway obstruction in children: Imaging essentials Carlos J. Sivit MD Rainbow Babies and Children’s Hospital Case Western Reserve School of Medicine ►Clinical perspective ►Infections ►Foreign body ►Masses 1 Clinical Clinical ► Common cause of respiratory failure in children ► Potentially life-threatening in younger children because of smaller airway diameter ► Narrowing of upper airway has exponential effect on airflow 2 Clinical ► Majority of children are otherwise healthy ► Appropriate management results in good outcomes ► Improper management has dire consequences ► Imaging plays critical role in diagnosis Clinical ► Signs and symptoms § Respiratory distress § Dysphagia § Odynophagia § Stridor § Absence of air entry § Tachycardia 3 Stridor ► Harsh respiratory noise caused by turbulent air flow through narrowed airway ► Specific for severe upper airway obstruction ► Intensifies in inspiration ► Does not help specify nature or location Infections 4 Infections ► Acute laryngotracheobronchitis ► Acute epiglottitis ► Acute bacterial tracheitis ► Retropharyngeal abscess ► Infectious mononucleosis Croup ► Heterogenous group of acute infections characterized by brassy “croupy” cough ► May or may not be accompanied by stridor, hoarseness and respiratory distress ► Typically seen in younger children § 6 months – 5 years 5 Croup ► Parainfluenza viruses account for 75% ► Adenoviruses, RSV, influenza and measles cause most remaining cases ► Secondary bacterial infection is rare Imaging ►Imaging § Performed to exclude other conditions
    [Show full text]
  • Clinical Excellence Series Volume VI an Evidence-Based Approach to Infectious Disease
    Clinical Excellence Series n Volume VI An Evidence-Based Approach To Infectious Disease Inside The Young Febrile Child: Evidence-Based Diagnostic And Therapeutic Strategies Pharyngitis In The ED: Diagnostic Challenges And Management Dilemmas HIV-Related Illnesses: The Challenge Of Emergency Department Management Antibiotics In The ED: How To Avoid The Common Mistake Of Treating Not Wisely, But Too Well Brought to you exclusively by the publisher of: An Evidence-Based Approach To Infectious Disease CEO: Robert Williford President & Publisher: Stephanie Ivy Associate Editor & CME Director: Jennifer Pai • Associate Editor: Dorothy Whisenhunt Director of Member Services: Liz Alvarez • Marketing & Customer Service Coordinator: Robin Williford Direct all questions to EB Medicine: 1-800-249-5770 • Fax: 1-770-500-1316 • Non-U.S. subscribers, call: 1-678-366-7933 EB Medicine • 5550 Triangle Pkwy Ste 150 • Norcross, GA 30092 E-mail: [email protected] • Web Site: www.ebmedicine.net The Emergency Medicine Practice Clinical Excellence Series, Volume Volume VI: An Evidence-Based Approach To Infectious Disease is published by EB Practice, LLC, d.b.a. EB Medicine, 5550 Triangle Pkwy Ste 150, Norcross, GA 30092. Opinions expressed are not necessarily those of this publication. Mention of products or services does not constitute endorsement. This publication is intended as a general guide and is intended to supplement, rather than substitute, professional judgment. It covers a highly technical and complex subject and should not be used for making specific medical decisions. The materials contained herein are not intended to establish policy, procedure, or standard of care. Emergency Medicine Practice, The Emergency Medicine Practice Clinical Excellence Series, and An Evidence-Based Approach To Infectious Disease are trademarks of EB Practice, LLC, d.b.a.
    [Show full text]
  • Since January 2020 Elsevier Has Created a COVID-19 Resource Centre with Free Information in English and Mandarin on the Novel Coronavirus COVID- 19
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by IUPUIScholarWorks Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- 19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. A02842_052 4/11/06 3:59 PM Page 813 Chapter 52 Otolaryngologic Disorders William P. Potsic and Ralph F. Wetmore EAR vibrating tympanic membrane to the stapes footplate. Anatomy Stapes movement creates a fluid wave in the inner ear that travels to the round window membrane and is dissi- The ear is divided into three anatomic and functional pated by reciprocal motion to the stapes. areas: the external ear, the middle ear, and the inner ear. There are two striated muscles in the middle ear. The The external ear consists of the auricle, external auditory tensor tympani muscle lies along the side of the eustachian canal, and the lateral surface of the tympanic membrane. tube, and its tendon attaches to the medial surface of the The auricle is a complex fibroelastic skeleton that is cov- malleus.
    [Show full text]
  • NIOSH), Centers for Disease Control and Prevention (CDC)
    Technical Report Filtering Facepiece Respirators with an Exhalation Valve: Measurements of Filtration Efficiency to Evaluate Their Potential for Source Control Centers for Disease Control and Prevention National Institute for Occupational Safety and Health Technical Report Filtering Facepiece Respirators with an Exhalation Valve: Measurements of Filtration Efficiency to Evaluate Their Potential for Source Control DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Institute for Occupational Safety and Health National Personal Protective Technology Laboratory This document is in the public domain and may be freely copied or reprinted. Disclaimer Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in this document were accessible as of the publication date. Get More Information Find NIOSH products and get answers to workplace safety and health questions: 1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348 CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh Monthly NIOSH eNews: cdc.gov/niosh/eNews Suggested Citation NIOSH [2020]. Filtering facepiece respirators with an exhalation valve: measurements of filtration efficiency to evaluate their potential for source control. By Portnoff L, Schall J, Brannen J, Suhon N, Strickland K, Meyers J. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No.
    [Show full text]
  • Physical and Geometric Constraints Shape the Labyrinth-Like Nasal Cavity
    Physical and geometric constraints shape the labyrinth-like nasal cavity David Zwickera,b,1, Rodolfo Ostilla-Monico´ a,b, Daniel E. Liebermanc, and Michael P. Brennera,b aJohn A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138; bKavli Institute for Bionano Science and Technology, Harvard University, Cambridge, MA 02138; and cDepartment of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138 Edited by Leslie Greengard, New York University, New York, NY, and approved January 26, 2018 (received for review August 29, 2017) The nasal cavity is a vital component of the respiratory system take into account geometric constraints imposed by the shape that heats and humidifies inhaled air in all vertebrates. Despite of the head that determine the length of the nasal cavity, its this common function, the shapes of nasal cavities vary widely cross-sectional area, and, generally, the shape of the space that it across animals. To understand this variability, we here connect occupies. To tackle this complex problem, we first show that, nasal geometry to its function by theoretically studying the air- without geometric constraints, optimal shapes have slender flow and the associated scalar exchange that describes heating cross-sections. We then demonstrate that these shapes can be and humidification. We find that optimal geometries, which have compacted into the typical labyrinth-like shapes without much minimal resistance for a given exchange efficiency, have a con- loss in performance. stant gap width between their side walls, while their overall shape can adhere to the geometric constraints imposed by the Results head. Our theory explains the geometric variations of natural The Flow in the Nasal Cavity Is Laminar.
    [Show full text]
  • Standardisation of Spirometry
    Eur Respir J 2005; 26: 319–338 DOI: 10.1183/09031936.05.00034805 CopyrightßERS Journals Ltd 2005 SERIES ‘‘ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING’’ Edited by V. Brusasco, R. Crapo and G. Viegi Number 2 in this Series Standardisation of spirometry M.R. Miller, J. Hankinson, V. Brusasco, F. Burgos, R. Casaburi, A. Coates, R. Crapo, P. Enright, C.P.M. van der Grinten, P. Gustafsson, R. Jensen, D.C. Johnson, N. MacIntyre, R. McKay, D. Navajas, O.F. Pedersen, R. Pellegrino, G. Viegi and J. Wanger CONTENTS AFFILIATIONS Background ............................................................... 320 For affiliations, please see Acknowledgements section FEV1 and FVC manoeuvre .................................................... 321 Definitions . 321 CORRESPONDENCE Equipment . 321 V. Brusasco Requirements . 321 Internal Medicine University of Genoa Display . 321 V.le Benedetto XV, 6 Validation . 322 I-16132 Genova Quality control . 322 Italy Quality control for volume-measuring devices . 322 Fax: 39 103537690 E-mail: [email protected] Quality control for flow-measuring devices . 323 Test procedure . 323 Received: Within-manoeuvre evaluation . 324 March 23 2005 Start of test criteria. 324 Accepted after revision: April 05 2005 End of test criteria . 324 Additional criteria . 324 Summary of acceptable blow criteria . 325 Between-manoeuvre evaluation . 325 Manoeuvre repeatability . 325 Maximum number of manoeuvres . 326 Test result selection . 326 Other derived indices . 326 FEVt .................................................................. 326 Standardisation of FEV1 for expired volume, FEV1/FVC and FEV1/VC.................... 326 FEF25–75% .............................................................. 326 PEF.................................................................. 326 Maximal expiratory flow–volume loops . 326 Definitions. 326 Equipment . 327 Test procedure . 327 Within- and between-manoeuvre evaluation . 327 Flow–volume loop examples. 327 Reversibility testing . 327 Method .
    [Show full text]
  • Influence of Inhalation/Exhalation Ratio and of Respiratory
    sustainability Article Slow-Paced Breathing: Influence of Inhalation/Exhalation Ratio and of Respiratory Pauses on Cardiac Vagal Activity Sylvain Laborde 1,2,* , Maša Iskra 1, Nina Zammit 1, Uirassu Borges 1,3, Min You 4, Caroline Sevoz-Couche 5 and Fabrice Dosseville 6,7 1 Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne 50933, Germany; [email protected] (M.I.); [email protected] (N.Z.) 2 UFR STAPS, EA 4260 CESAMS, Normandie Université, 14000 Caen, France 3 Department of Health & Social Psychology, Institute of Psychology, German Sport University Cologne, 50933 Cologne, Germany; [email protected] 4 UFR Psychologie, EA3918 CERREV, Normandie Université, 14000 Caen, France; [email protected] 5 INSERM, Unité Mixte de Recherche (UMR) S1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75000 Paris, France; [email protected] 6 UMR-S 1075 COMETE, Normandie Université, 14000 Caen, France 7 INSERM, UMR-S 1075 COMETE, 14000 Caen, France; [email protected] * Correspondence: [email protected]; Tel.: +49-221-49-82-57-01 Abstract: Slow-paced breathing has been shown to enhance the self-regulation abilities of athletes via its influence on cardiac vagal activity. However, the role of certain respiratory parameters (i.e., inhalation/exhalation ratio and presence of a respiratory pause between respiratory phases) still needs to be clarified. The aim of this experiment was to investigate the influence of these respiratory Citation: Laborde, S.; Iskra, M.; parameters on the effects of slow-paced breathing on cardiac vagal activity. A total of 64 athletes Zammit, N.; Borges, U.; You, M.; (27 female; Mage = 22, age range = 18–30 years old) participated in a within-subject experimental Sevoz-Couche, C.; Dosseville, F.
    [Show full text]
  • A Review of the Breathing Mechanism for Singing
    A Review of the Breathing Mechanism for Singing: Part I: Anatomy Dr. Sean McCarther Breathing is important for singing. In fact, many argue that a properly coordinated breathing mechanism is one of, if not the most important components of a vocal technique. As my former teacher, Dr. Robert Harrison, is fond of saying, “No air, no sound.” It is our responsibility as teachers of singing to help students learn to coordinate the muscles and organs of the breathing mechanism in such a way as to produce the most efficient and vibrant sound. Part I of this series will focus on the anatomy of the breathing mechanism. It will review the major organs, muscles, and bones and discuss how they interact with each other for both passive and active breathing. Part II will examine the singer’s breath in greater detail and discuss various ways the system can be used for singing, including a description of appoggio. The Lungs and Lower Airway The lungs are made of a porous, spongy material that is somewhat elastic in nature (its elasticity is an important part of exhalation, but more on that later). The lungs attach to the ribs via the pleural sacs, two thin pieces of membrane that cause the lungs to adhere to the ribs. Because of this connection, any change in the volume of the rib cage causes a similar change in the volume of the lungs. As the volume of the lungs increase, a vacuum is created, causing air to rush in and fill the lungs. This is called inhalation.
    [Show full text]