Cardiology

Cardiopulmonary physiotherapy by M Jones; F Moffatt

By M Jones; F Moffatt

content material: part 1: overview instruments part 2: Pathophysiology part three: Physiotherapy recommendations and Adjuncts part four: Case reports and Self-Assessment

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Anemia), reduced tissue blood flow, or reduced arterial saturation (hypoxemia). g. g. interstitial lung disease) or from inequalities in the relationship between alveolar ventilation and blood flow (ventilationperfusion mismatch). Key physiological principles • The movement of oxygen from the atmosphere to its ultimate site of utilization in the body’s cells involves many different processes. Movement through the airways takes place by convection and diffusion. • Diffusion is then the main transport mechanism across the alveolar-capillary membrane through the plasma to the red blood cell, where oxygen combines with hemoglobin.

G. g. emphysema, pulmonary fibrosis. g. in CAL hypoxia and destruction of the pulmonary vascular bed contribute to raised pulmonary artery pressures. • Pulmonary hypertension in most lung conditions is normally fairly modest (< 45 mmHg), but may be severe in primary pulmonary hypertension and pulmonary hypertension secondary to recurrent thromboembolic disease, where pulmonary artery pressures may reach systemic levels. • Long-term oxygen therapy (LTOT) (>16 hours/day) may be of benefit in the treatment of pulmonary hypertension in some patients with CAL.

A typical compliance curve is shown in Figure 1. • Normal compliance is maintained by regular respiratory cycling with an effective tidal volume. • Surfactant is an important determinant of compliance. The lipoprotein mixture secreted by alveolar epithelial cells reduces the surface tension in the alveoli and therefore increases the compliance of the lung. • Surfactant also stabilizes the alveoli protecting against collapse and the transudation of fluid from the capillaries. e. inspiratory effort is necessary for the same change in volume (Figure 1).

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