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Clinical Application Of Mechanical Ventilation

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Edition:
3rd
ISBN13:

9781401884857

ISBN10:
1401884857
Format:
Paperback
Pub. Date:
9/6/2005
Publisher(s):
Cengage Learning
List Price: $211.95

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Summary

With a concise and easy-to-read approach, the new edition of this book integrates the essential concepts of respiratory physiology with the clinical application of mechanical ventilation. Extensive coverage of airway management and weaning criteria, and a concise view of pharmacotherapy for mechanical ventilation are included. Each chapter features visual examples illustrating concepts, key points summarized in margin references, and assessment questions written in NRBC format, to help prepare learners to sit for the exam. Fifteen case studies enable learners to apply theoretical knowledge to real-world critical thinking situations they may face in the field.

Table of Contents

Foreword xxv
George G. Burton
Preface xxvii
Acknowledgments xxix
Contributors xxxi
Principles of Mechanical Ventilation
1(27)
Key Terms
2(1)
Introduction
2(1)
Airway Resistance
2(3)
Factors Affecting Airway Resistance
3(1)
Airway Resistance and the Work of Breathing (ΔP)
4(1)
Effects on Ventilation and Oxygenation
4(1)
Airflow Resistance
5(1)
Lung Compliance
5(5)
Compliance Measurement
6(1)
Static and Dynamic Compliance
7(3)
Compliance and the Work of Breathing
10(1)
Effects on Ventilation and Oxygenation
10(1)
Deadspace Ventilation
10(2)
Anatomic Deadspace
11(1)
Alveolar Deadspace
11(1)
Physiologic Deadspace
12(1)
Ventilatory Failure
12(5)
Hypoventilation
13(1)
Ventilation/Perfusion (V/Q) Mismatch
14(1)
Intrapulmonary Shunting
14(2)
Diffusion Defect
16(1)
Oxygenation Failure
17(1)
Hypoxemia and Hypoxia
17(1)
Clinical Conditions Leading to Mechanical Ventilation
18(3)
Depressed Respiratory Drive
19(2)
Excessive Ventilatory Workload
21(1)
Failure of Ventilatory Pump
21(1)
Summary
21(1)
Self-Assessment Questions
22(2)
Answers to Self-Assessment Questions
24(1)
References
25(2)
Suggested Reading
27(1)
Effects of Positive Pressure Ventilation
28(26)
Key Terms
29(1)
Introduction
29(1)
Pulmonary Considerations
29(3)
Spontaneous Breathing
29(1)
Positive Pressure Ventilation
30(1)
Airway Pressures
31(1)
Compliance
31(1)
Cardiovascular Considerations
32(4)
Mean Airway Pressure and Cardiac Output
32(1)
Decrease in Cardiac Output and O2 Delivery
33(1)
Blood Pressure Changes
34(1)
Pulmonary Blood Flow and Thoracic Pump Mechanism
34(2)
Hemodynamic Considerations
36(2)
Positive Pressure Ventilation
36(1)
Positive End-Expiratory Pressure
36(2)
Renal Considerations
38(2)
Renal Perfusion
38(1)
Indicators of Renal Failure
38(1)
Effects of Renal Failure on Drug Clearance
38(2)
Hepatic Considerations
40(1)
PEEP and Hepatic Perfusion
40(1)
Indicators of Liver Dysfunction
40(1)
Effects of Decreased Hepatic Perfusion on Drug Clearance
41(1)
Abdominal Considerations
41(1)
Effects of PEEP and Increased Intra-Abdominal Pressure
41(1)
Gastrointestinal Considerations
42(1)
Nutritional Considerations
43(2)
Muscle Fatigue
43(1)
Nutritional Support
43(1)
Nutrition and the Work of Breathing
44(1)
Neurologic Considerations
45(2)
Hyperventilation
45(1)
Ventilatory and Oxygenation Failure
45(1)
Indicators of Neurologic Impairment
46(1)
Summary
47(1)
Self-Assessment Questions
47(3)
Answers to Self-Assessment Questions
50(2)
References
52(2)
Classification of Mechanical Ventilators
54(26)
Key Terms
55(1)
Introduction
55(1)
Ventilator Classification
55(1)
Ventilatory Work
56(1)
Input Power
57(1)
Drive Mechanism
57(3)
Piston Drive Mechanism
58(1)
Bellows Drive Mechanism
59(1)
Reducing Valve Drive Mechanism
59(1)
Microprocessor-Controlled Pneumatic Drive Mechanism
59(1)
Control Circuit
60(2)
Mechanical
60(1)
Pneumatic
60(1)
Fluidics
60(1)
Electric
61(1)
Electronic
62(1)
Control Variables
62(2)
Pressure Controller
62(2)
Volume Controller
64(1)
Flow Controller
64(1)
Time Controller
64(1)
Phase Variables
64(5)
Trigger Variable
65(2)
Limit Variable
67(1)
Cycle Variable
67(1)
Baseline Variable
68(1)
Conditional Variable
69(1)
Output Waveforms
69(6)
Pressure Waveforms
72(2)
Volume Waveforms
74(1)
Flow Waveforms
74(1)
Alarm Systems
75(3)
Input Power Alarms
75(2)
Control Circuit Alarms
77(1)
Output Alarms
77(1)
Summary
78(1)
Self-Assessment Questions
78(1)
Answers to Self-Assessment Questions
79(1)
Suggested Reading
79(1)
Operating Modes of Mechanical Ventilation
80(43)
Key Terms
81(1)
Introduction
81(1)
Negative and Positive Pressure Ventilation
82(2)
Negative Pressure Ventilation
82(1)
Positive Pressure Ventilation
83(1)
Operating Modes of Mechanical Ventilation
84(1)
Spontaneous
84(1)
Apnea Ventilation
85(1)
Positive End-Expiratory Pressure (PEEP)
85(4)
Indications for PEEP
86(1)
Physiology of PEEP Therapy
86(1)
Complications Associated with PEEP
87(2)
Continuous Positive Airway Pressure (CPAP)
89(1)
Bilevel Positive Airway Pressure (BiPAP)
90(1)
Indications for BiPAP
90(1)
Initial Settings
90(1)
Adjustments of IPAP and EPAP
90(1)
Controlled Mandatory Ventilation (CMV)
91(2)
Indications for the Control Mode
92(1)
Complications Associated with the Control Mode
92(1)
Assist Control (AC)
93(2)
Assist Control Triggering Mechanism
93(1)
Assist Control Cycling Mechanism
94(1)
Indications for the AC Mode
94(1)
Advantages of the AC Mode
94(1)
Complications Associated with the AC Mode
94(1)
Intermittent Mandatory Ventilation (IMV)
95(1)
Synchronized Intermittent Mandatory Ventilation (SIMV)
96(4)
SIMV Mandatory Breath-Triggering Mechanism
97(1)
SIMV Spontaneous Breath-Triggering Mechanism
98(1)
Indications for the SIMV Mode
98(1)
Advantages of the SIMV Mode
98(1)
Complications Associated with the SIMV Mode
99(1)
Mandatory Minute Ventilation (MMV)
100(2)
Pressure Support Ventilation (PSV)
102(2)
Indications for the PSV Mode
103(1)
Adaptive Support Ventilation (ASV)
104(1)
Proportional Assist Ventilation (PAV)
105(1)
Volume-Assured Pressure Support (VAPS)
106(1)
Pressure-Regulated Volume Control (PRVC)
106(1)
Automode
107(1)
Volume Ventilation Plus (VV+)
107(1)
Volume Control Plus (VC+)
107(1)
Volume Support (VS)
108(1)
Pressure Control Ventilation (PCV)
108(2)
Airway Pressure Release Ventilation (APRV)
110(2)
Indications for the APRV Mode
111(1)
Inverse Ratio Ventilation (IRV)
112(1)
Physiology of IRV
112(1)
Adverse Effects of IRV
112(1)
Pressure Control-IRV (PC-IRV)
113(1)
Automatic Tube Compensation
113(1)
Summary
114(1)
Self-Assessment Questions
114(2)
Answers to Self-Assessment Questions
116(1)
References
117(4)
Suggested Reading
121(2)
Special Airways for Ventilation
123(25)
Key Terms
124(1)
Introduction
124(1)
Oropharyngeal Airway
124(3)
Types of Oropharyngeal Airways
124(1)
Selection of Oropharyngeal Airway
125(1)
Insertion of Oropharyngeal Airway
126(1)
Esophageal Obturator Airway (EOA)
127(1)
Insertion of EOA
127(1)
Esophageal Gastric Tube Airway (EGTA)
128(1)
Laryngeal Mask Airway (LMA)
129(6)
Use and Application of LMA
130(1)
Contraindications for LMA
130(2)
Selection of LMA
132(1)
Insertion of LMA
132(1)
Removal of LMA
132(2)
Limitations of LMA
134(1)
Pharyngealtracheal Lumen Airway (PTLA)
135(2)
Insertion and Use of PTLA
136(1)
Complications with Use of PTLA
137(1)
Double-Lumen Endobronchial Tube
137(4)
Indications
137(1)
Selection of DLT
137(2)
Insertion of DLT
139(1)
Risk Factors for Airway Rupture
139(2)
Summary
141(1)
Self-Assessment Questions
141(2)
Answers to Self-Assessment Questions
143(1)
References
144(3)
Suggested Reading
147(1)
Airway Management in Mechanical Ventilation
148(42)
Key Terms
149(1)
Introduction
149(1)
Intubation
149(2)
Indications
151(1)
Common Artificial Airways in Mechanical Ventilation
151(2)
Oral Endotracheal Tube
151(1)
Nasal Endotracheal Tube
152(1)
Tracheostomy Tube
152(1)
Intubation Procedure
153(11)
Pre-Intubation Assessment
153(1)
Supplies
153(5)
Selection of Endotracheal Tube
158(1)
Ventilation and Oxygenation
158(1)
Oral Intubation
159(1)
Nasal Intubation
159(3)
Common Errors
162(1)
Signs of Endotracheal Intubation
162(2)
Signs of Esophageal Intubation
164(1)
Rapid Sequence Intubation
164(3)
Indications and Contraindications
165(1)
Practice Guidelines
165(2)
Management of Endotracheal and Tracheostomy Tubes
167(6)
Securing Endotracheal and Tracheostomy Tubes
168(1)
Cuff Pressure
169(1)
Minimal Occlusion Volume and Minimal Leak Technique
169(1)
Irrigation and Suction
170(3)
Speaking Valves
173(2)
Contraindications
173(1)
Safety Requirements
174(1)
Positive-Pressure Ventilation
175(1)
Extubation
175(3)
Predictors of Successful Extubation
175(1)
Procedure
176(1)
Unplanned Extubation
177(1)
Complications of Endotracheal Airway
178(3)
During Intubation
179(1)
While Intubated
180(1)
Immediately after Extubation
180(1)
Following Extubation
181(1)
Summary
181(1)
Self-Assessment Questions
181(3)
Answers to Self-Assessment Questions
184(1)
References
185(4)
Suggested Reading
189(1)
Noninvasive Positive Pressure Ventilation
190(21)
Key Terms
191(1)
Introduction
191(1)
Terminology
192(1)
Physiologic Effects of NPPV
192(1)
Use of Continuous Positive Airway Pressure (CPAP)
193(2)
Obstructive Sleep Apnea
193(2)
Use of Bilevel Positive Airway Pressure (BiPAP)
195(2)
Common Interfaces for CPAP and Bilevel PAP
197(4)
Nasal Mask
197(1)
Facial Mask
197(1)
Nasal Pillows™
198(3)
Potential Problems with Interfaces
201(1)
Titration of Continuous Positive Airway Pressure
201(2)
Autotitration
202(1)
Ramp
202(1)
C-Flex™
202(1)
Titration of Bilevel Positive Airway Pressures
203(1)
Bi-Flex™
203(1)
Summary
204(1)
Self-Assessment Questions
204(3)
Answers to Self-Assessment Questions
207(1)
References
207(3)
Suggested Reading
210(1)
Initiation of Mechanical Ventilation
211(27)
Key Terms
212(1)
Introduction
212(1)
Indications
212(4)
Acute Ventilatory Failure
212(1)
Impending Ventilatory Failure
213(2)
Severe Hypoxemia
215(1)
Prophylactic Ventilatory Support
216(1)
Contraindications
216(1)
Initial Ventilator Settings
217(9)
Mode
217(1)
Dual-Control Mode
218(1)
Respiratory Rate
218(1)
Tidal Volume
219(2)
F1O2
221(1)
PEEP
221(1)
I:E Ratio
222(1)
Flow Pattern
222(4)
Ventilator Alarm Settings
226(1)
Low Exhaled Volume Alarm
226(1)
Low Inspiratory Pressure Alarm
226(1)
High Inspiratory Pressure Alarm
226(1)
Apnea Alarm
227(1)
High Respiratory Rate Alarm
227(1)
High and Low F1O2 Alarms
227(1)
Hazards and Complications
227(4)
Types of Hazards and Complications
228(1)
Malfunction and Misuse of Alarms
228(1)
Barotrauma (Volutrauma)
229(1)
Decrease in Cardiac Output and Blood Pressure
229(2)
Summary
231(1)
Self-Assessment Questions
232(2)
Answers to Self-Assessment Questions
234(1)
References
235(2)
Suggested Reading
237(1)
Monitoring in Mechanical Ventilation
238(34)
Key Terms
239(1)
Introduction
239(1)
Vital Signs
239(4)
Heart Rate
239(1)
Blood Pressure
240(1)
Respiratory Rate
241(1)
Temperature
242(1)
Chest Inspection and Auscultation
243(3)
Chest Movement
243(1)
Auscultation
243(3)
Fluid Balance and Anion Gap
246(2)
Fluid Balance
247(1)
Anion Gap
247(1)
Arterial Blood Gases
248(4)
Assessment of Ventilatory Status
249(1)
Assessment of Oxygenation Status
250(2)
Limitations of Blood Gases
252(1)
Oxygen Saturation Monitoring
252(4)
Pulse Oximetry
252(3)
Accuracy and Clinical Use of Pulse Oximetry
255(1)
Limitations of Pulse Oximetry
255(1)
Innovations in Pulse Oximetry
256(1)
End-Tidal Carbon Dioxide Monitoring
256(5)
Capnography
256(3)
Capnography Waveforms and Clinical Applications
259(1)
P(a-et)CO2 Gradient
260(1)
Limitations of Capnography Monitoring
261(1)
Transcutaneous Blood Gas Monitoring
261(2)
Transcutaneous PO2 (PtcO2)
263(1)
Transcutaneous PCO2 (PtcCO2)
263(1)
Cerebral Perfusion Pressure
263(1)
Summary
264(1)
Self-Assessment Questions
265(3)
Answers to Self-Assessment Questions
268(1)
References
268(3)
Suggested Reading
271(1)
Hemodynamic Monitoring
272(31)
Key Terms
273(1)
Introduction
273(1)
Hemodynamic Monitoring
273(2)
Technical Background
273(1)
Units of Measurement
274(1)
Types of Catheters
274(1)
Arterial Catheter
275(4)
Insertion of Arterial Catheter
275(1)
Normal Arterial Pressure and Mean Arterial Pressure
276(1)
Pulse Pressure
277(1)
Potential Problems with Arterial Catheter
278(1)
Central Venous Catheter
279(2)
Insertion of Central Venous Catheter
279(1)
Components of Central Venous Pressure Waveform
279(1)
Normal CVP Measurement
280(1)
Changes in CVP Measurement
281(1)
Pulmonary Artery Catheter
281(8)
Insertion of Pulmonary Artery Catheter
282(1)
Components of Pulmonary Arterial Pressure Waveform
283(1)
Abnormal Pulmonary Arterial Pressure
283(3)
Pulmonary Capillary Wedge Pressure
286(1)
Components of Pulmonary Capillary Wedge Pressure Waveform
287(1)
Abnormal Pulmonary Capillary Wedge Pressure
288(1)
Verification of the Wedged Position
288(1)
Cardiac Output and Cardiac Index
289(1)
Summary of Preloads and Afterloads
289(1)
Calculated Hemodynamic Values
290(1)
Stroke Volume and Stroke Volume Index
290(1)
Oxygen Consumption and Oxygen Consumption Index
291(1)
Pulmonary Vascular Resistance
291(1)
Systemic Vascular Resistance
291(1)
Monitoring of Mixed Venous Oxygen Saturation
291(2)
Decrease in Mixed Venous Oxygen Saturation
292(1)
Increase in Mixed Venous Oxygen Saturation
293(1)
Impedance Cardiography
293(4)
Theory of Operation
293(2)
Thermodilution Method and ICG
295(1)
Accuracy of ICG
296(1)
Clinical Applications
296(1)
Summary
297(1)
Self-Assessment Questions
297(2)
Answers to Self-Assessment Questions
299(1)
References
300(3)
Ventilator Waveform Analysis
303(72)
Key Terms
304(1)
Introduction
304(2)
Flow Waves Used for Positive Pressure Ventilation
306(1)
Effects of Constant Flow during Volume-Controlled Ventilation
307(13)
Flow-Time Waveform
307(2)
Pressure-Time Waveform
309(4)
Controlled Mechanical Ventilation
313(1)
Assist Mandatory Volume-Controlled Ventilation
314(4)
Mathematical Analysis of Constant Flow Waveform
318(2)
Spontaneous Ventilation during Mechanical Ventilation
320(2)
Synchronized Intermittent Mandatory Ventilation
320(2)
Continuous Positive Airway Pressure
322(1)
Effects of Flow, Circuit, and Lung Characteristics on Pressure-Time Waveforms
322(3)
Flow and Transairway Pressure
322(2)
Compliance and Alveolar Pressure
324(1)
Effects of Descending Ramp Flow Waveform during Volume-Controlled Ventilation
325(10)
Time- and Flow-Limited Ventilation
325(5)
Peak Flow and Tidal Volume Relationship in Time-Limited Ventilation
330(1)
Effects of End-Flow on Tidal Volume
331(1)
Distribution of Delivered Tidal Volume
332(2)
CMV during Descending Ramp Flow Waveform (DRFW) Ventilation
334(1)
Waveforms Developed during Pressure-Limited Ventilation
335(3)
Pressure-Controlled Ventilation (PCV)
335(2)
Inverse Ratio Pressure-Controlled Ventilation (IRPCV)
337(1)
Pressure Support and Spontaneous Ventilation
338(4)
Pressure Support Ventilation (PSV)
338(2)
Adjusting Rise Time During PSV
340(1)
SIMV (CFW) and PSV
341(1)
SIMV (DRFW) and PSV
342(1)
Effects of Lung Characteristics on Pressure-Limited Waveform
342(2)
Using Waveforms for Patient and Ventilator-System Assessment
344(8)
Patient-Ventilator Dyssynchrony
345(1)
Dyssynchrony during Constant Flow Waveform (CFW) Ventilation
346(3)
Dyssynchrony during Descending Ramp Flow Waveform (DRFW) Ventilation
349(1)
Changes in Pressure Waveforms during Respiratory Mechanics Measurement
349(2)
Dyssynchrony during Pressure-Limited Ventilation
351(1)
Using Expiratory Flow and Pressure Waveforms as Diagnostic Tools
352(6)
Increased Airway Resistance
352(2)
Loss of Elastic Recoil
354(1)
Decreased Lung-Thorax Compliance (CLT)
354(1)
Gas Trapping and Uncounted Breathing Efforts
355(3)
Troubleshooting Ventilator Function
358(2)
Lack of Ventilator Response
358(1)
Circuit Leaks
358(2)
Pressure-Volume Loop (PVL) and Flow-Volume Loop (FVL)
360(5)
Pressure-Volume Loop (PVL)
360(1)
Effects of Lung-Thorax Compliance on PVL
360(2)
Effect of Airflow Resistance on PVL
362(1)
Lower Inflection Point on PVL and Titration of PEEP
362(2)
Upper Inflection Point on PVL and Adjustment of VT
364(1)
Effects of Airway Status on Flow-Volume Loop (FVL)
364(1)
Summary
365(1)
Self-Assessment Questions
366(5)
Answers to Self-Assessment Questions
371(2)
References
373(1)
Suggested Reading
374(1)
Management of Mechanical Ventilation
375(48)
Key Terms
376(1)
Introduction
376(1)
Basic Management Strategies
377(1)
Strategies to Improve Ventilation
377(5)
Increase Mechanical Rate
378(1)
Increase Spontaneous Tidal Volume or Rate
379(1)
Increase Mechanical Tidal Volume
380(1)
Other Strategies to Improve Ventilation
380(1)
Permissive Hypercapnia
380(2)
Strategies to Improve Oxygenation
382(6)
Increase Inspired Oxygen Fraction (F1O2)
382(1)
Improve Ventilation and Reduce Mechanical Deadspace
383(1)
Improve Circulation
384(1)
Maintain Normal Hemoglobin Level
384(1)
Initiate Continuous Positive Airway Pressure (CPAP)
384(1)
Initiate Positive End-Expiratory Pressure (PEEP)
385(1)
Inverse Ratio Ventilation (IRV)
386(1)
Extracorporeal Membrane Oxygenation (ECMO)
386(1)
High Frequency Oscillatory Ventilation for Adults
387(1)
Acid-Base Balance
388(2)
Respiratory Acidosis and Compensated Metabolic Alkalosis
388(1)
Respiratory Alkalosis and Compensated Metabolic Acidosis
389(1)
Metabolic Acid-Base Abnormalities
390(1)
Troubleshooting of Common Ventilator Alarms and Events
390(6)
Low Pressure Alarm
390(1)
Low Expired Volume Alarm
391(1)
High Pressure Alarm
392(1)
High Respiratory Rate Alarm
392(1)
Apnea/Low Respiratory Rate Alarm
393(1)
High PEEP Alarm
393(1)
Low PEEP Alarm
393(1)
Auto-PEEP
393(3)
Care of the Ventilator Circuit
396(3)
Circuit Compliance
396(1)
Circuit Patency
396(2)
Humidity and Temperature
398(1)
Frequency of Circuit Change
398(1)
Care of the Artificial Airway
399(3)
Patency of the Endotracheal Tube
399(1)
Humidification and Removal of Secretions
400(1)
Ventilator-Associated Pneumonia
400(2)
Fluid Balance
402(2)
Distribution of Body Water
402(1)
Clinical Signs of Extracellular Fluid Deficit or Excess
403(1)
Treatment of Extracellular Fluid Abnormalities
403(1)
Electrolyte Balance
404(3)
Normal Electrolyte Balance
404(1)
Sodium Abnormalities
405(1)
Potassium Abnormalities
406(1)
Nutrition
407(3)
Undernutrition
407(1)
Overfeeding
407(1)
Low-Carbohydrate High-Fat Diet
408(1)
Total Caloric Requirements
409(1)
Phosphate Supplement
410(1)
Adjunctive Management Strategies
410(3)
Low Tidal Volume
410(1)
Prone Positioning
411(1)
Tracheal Gas Insufflation
412(1)
Summary
413(1)
Self-Assessment Questions
414(2)
Answers to Self-Assessment Questions
416(1)
References
417(5)
Suggested Reading
422(1)
Procedures Related to Mechanical Ventilation
423(32)
Key Terms
424(1)
Introduction
424(1)
Chest Tube and Drainage System
424(9)
Indications for Chest Tube
424(1)
Chest Tube Selection and Placement
425(1)
Methods of Placement
426(3)
Chest Tube Drainage System
429(3)
Care and Removal of Chest Tube
432(1)
Transport with Chest Tube
432(1)
Assisting in Fiberoptic Bronchoscopy
433(9)
Indications for Fiberoptic Bronchoscopy
433(2)
Bronchoscope and Medications
435(2)
Insertion of Bronchoscope
437(1)
Types of Specimen
437(3)
Complications
440(1)
Postbronchoscopy Care
441(1)
Transport of Mechanically Ventilated Patients
442(5)
Indications
442(1)
Contraindications
442(1)
Equipment and Supplies
442(1)
Types of Transport
443(2)
Procedures for Interhospital Transport
445(1)
Hazards and Complications
446(1)
Magnetic Resonance Imaging
446(1)
Summary
447(1)
Self-Assessment Questions
447(2)
Answers to Self-Assessment Questions
449(1)
References
450(4)
Suggested Reading
454(1)
Pharmacotherapy for Mechanical Ventilation
455(42)
Key Terms
456(1)
Introduction
456(1)
Drugs for Improving Ventilation
456(9)
The Autonomic Nervous System
457(1)
Adrenergic Bronchodilators (Sympathomimetics)
458(2)
Anticholinergic Bronchodilators (Parasympatholytics)
460(1)
Xanthine Bronchodilators
461(2)
Anti-Inflammatory Agents (Corticosteroids)
463(2)
Delivery of MDI Medications
465(1)
Neuromuscular Blocking Agents
465(9)
Mechanism of Action
466(2)
Characteristics of Neuromuscular Blocking Agents
468(1)
Factors Affecting Neuromuscular Blockade
468(3)
Adverse Effects
471(2)
Evaluation of Neuromuscular Blockade
473(1)
Sedatives and Antianxiety Agents (Benzodiazepines)
474(3)
Mechanism of Action
474(2)
Adverse Effects
476(1)
Assessment of Sedation
476(1)
Narcotic Analgesics
477(5)
Mechanism of Action
478(1)
Adverse Effects
479(2)
Clinical Considerations
481(1)
Assessment of Adequate Pain Control
482(1)
Agents for Seizures and Elevated Intracranial Pressure (Barbiturates)
482(2)
Mechanism of Action
483(1)
Adverse Effects
483(1)
Drug Interactions
484(1)
Other Agents Used in Mechanical Ventilation
484(5)
Propofol
484(1)
Haloperidol
485(2)
Nitric Oxide
487(2)
Summary
489(1)
Self-Assessment Questions
489(2)
Answers to Self Assessment Questions
491(1)
References
492(3)
Suggested Reading
495(2)
Weaning from Mechanical Ventilation
497(30)
Key Terms
498(1)
Introduction
498(1)
Definition of Weaning Success and Failure
498(2)
Weaning Success
499(1)
Weaning Failure
499(1)
Patient Condition Prior to Weaning
500(1)
Weaning Criteria
500(7)
Ventilatory Criteria
501(2)
Oxygenation Criteria
503(1)
Pulmonary Reserve
504(1)
Pulmonary Measurements
505(2)
Combined Weaning Indices
507(2)
Respiratory Frequency to Tidal Volume (f/VT) Ratio
507(1)
Simplified Weaning Index (SWI)
508(1)
Compliance Rate Oxygenation and Pressure (CROP) Index
508(1)
Weaning Procedure
509(4)
Spontaneous Breathing Trial
509(1)
SIMV
510(1)
Pressure Support Ventilation
511(1)
Others Modes of Partial Ventilatory Support
511(2)
Weaning Protocol
513(1)
Signs of Weaning Failure
513(1)
Causes of Weaning Failure
514(2)
Increase of Air Flow Resistance
514(1)
Decrease of Compliance
515(1)
Respiratory Muscle Fatigue
515(1)
Terminal Weaning
516(2)
Prior to Withdrawal
517(1)
Withdrawal
518(1)
Summary
518(1)
Self-Assessment Questions
518(2)
Answers to Self-Assessment Questions
520(1)
References
521(3)
Suggested Reading
524(3)
Neonatal Mechanical Ventilation
527(38)
Key Terms
528(1)
Introduction
528(1)
Intubation
528(2)
Indications
528(1)
Equipment
529(1)
Surfactant Replacement Therapy
530(4)
History
531(1)
Indications
531(1)
Types of Surfactant and Dosages
532(2)
Outcomes
534(1)
Nasal CPAP
534(1)
Use of Nasal CPAP
534(1)
Basic Principles of Neonatal Ventilation
535(3)
Pressure-Limited Ventilation
535(1)
Volume-Limited Ventilation
536(1)
Ventilator Circuits and Humidifiers
536(2)
Initiation of Neonatal Ventilator Support
538(3)
Indications for Mechanical Ventilation
538(1)
Initial Ventilator Parameters
539(2)
High Frequency Ventilation (HFV)
541(9)
High Frequency Positive Pressure Ventilation (HFPPV)
542(1)
High Frequency Jet Ventilation (HFJV)
543(1)
High Frequency Oscillatory Ventilation (HFOV)
544(3)
Initial HFOV Settings
547(3)
Other Methods of Ventilation
550(1)
Liquid Ventilation
550(1)
Extracorporeal Membrane Oxygenation (ECMO)
550(5)
History
551(1)
Patient Selection
551(1)
ECMO Criteria
551(1)
Mechanisms of Bypass
552(1)
Complications
553(2)
Summary
555(1)
Self-Assessment Questions
555(4)
Answers to Self-Assessment Questions
559(1)
References
560(3)
Suggested Reading
563(2)
Home Mechanical Ventilation
565(16)
Key Terms
566(1)
Introduction
566(1)
Goals of Home Mechanical Ventilation
566(1)
Indications
567(3)
Diseases that May Justify Home Mechanical Ventilation
567(3)
Patient Selection
570(2)
Desires of the Patient
570(1)
Desires of the Family
571(1)
Cost
571(1)
Available Resources
571(1)
Equipment Selection
572(3)
Types of Ventilatory Support
572(3)
Reliability and Safety
575(1)
Simplicity and Portability
575(1)
Resources for Home Mechanical Ventilation
575(1)
Summary
575(1)
Self-Assessment Questions
576(2)
Answers to Self-Assessment Questions
578(1)
References
579(1)
Suggested Reading
580(1)
Case Studies
581(74)
Case 1: COPD
582(5)
Case 2: Status Asthmaticus
587(4)
Case 3: Postabdominal Surgery
591(3)
Case 4: Head Injury
594(4)
Case 5: Smoke Inhalation
598(4)
Case 6: Drug Overdose
602(4)
Case 7: Tension Hemopneumothorax
606(5)
Case 8: Chest Trauma
611(6)
Case 9: Adult Respiratory Distress Syndrome
617(6)
Case 10: Myasthenia Gravis
623(5)
Case 11: Guillain-Barre
628(7)
Case 12: Botulism
635(4)
Case 13: Meconium Aspiration/Patent Ductus Arteriosus
639(4)
Case 14: Persistent Pulmonary Hypertension of the Newborn
643(3)
Case 15: Home Care and Disease Management
646(9)
APPENDIX 1: RESPIRATORY CARE CALCULATIONS
655(12)
Airway Resistance: Estimated (Raw)
655(1)
Alveolar-Arterial Oxygen Tension Gradient: P(A-a)O2
655(2)
Anion Gap
657(1)
Arterial Oxygen Tension to Inspired Oxygen Concentration (PaO2/F1O2) Index
657(1)
Compliance: Dynamic (CDYN)
658(1)
Compliance: Static (CST)
658(1)
Corrected Tidal Volume (VT)
659(1)
Deadspace to Tidal Volume Ratio (VD/VT)
660(1)
Mean Airway Pressure (mPaw)
660(1)
Minute Ventilation: Expired and Alveolar
661(1)
Oxygen Index (Ol)
662(1)
Shunt Equation (QSP/QT): Classic Physiologic
662(1)
Shunt Equation (QSP/QT): Estimated
663(1)
Ventilator Rate Neede0d for a Desired PaCO2
664(1)
Weaning Index: Rapid Shallow Breathing
665(1)
Weaning Index: Simplified
665(2)
APPENDIX 2: DUBOIS BODY SURFACE CHART
667(1)
APPENDIX 3: PRESSURE CONVERSIONS
668(1)
APPENDIX 4: FRENCH (FR) AND MILLIMETER (MM) CONVERSIONS
669(1)
APPENDIX 5: NORMAL ELECTROLYTE CONCENTRATIONS IN PLASMA
670(1)
APPENDIX 6: OXYGEN TRANSPORT NORMAL RANGES
671(1)
APPENDIX 7: HEMODYNAMIC NORMAL RANGES
672(3)
APPENDIX 8: GLASGOW COMA SCORE
675(1)
APPENDIX 9: APACHE II SEVERITY OF DISEASE CLASSIFICATION SYSTEM
676(2)
Index 678


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