Mechanical Ventilation Physiological and Clinical Applications

ISBN-10: 0323032362
ISBN-13: 9780323032360
Edition: 4th 2006 (Revised)
List price: $87.95
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Description: Reorganized to better reflect the order in which mechanical ventilation is typically taught, this text focuses on the management of patients who are receiving mechanical ventilatory support and provides clear discussion of mechanical ventilation and  More...

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Book details

List price: $87.95
Edition: 4th
Copyright year: 2006
Publisher: Elsevier - Health Sciences Division
Publication date: 2/8/2006
Binding: Paperback
Pages: 672
Size: 8.50" wide x 11.00" long x 1.25" tall
Weight: 3.234
Language: English

Reorganized to better reflect the order in which mechanical ventilation is typically taught, this text focuses on the management of patients who are receiving mechanical ventilatory support and provides clear discussion of mechanical ventilation and its application. The 4th edition features two-color illustrations, an increased focus on critical thinking, a continued emphasis on ventilator graphics, and several new chapters including non-invasive positive pressure ventilation and long-term ventilation. Excerpts of the most recent CPGs are included to give students important information regarding indications/contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring. Clinical Rounds boxes contain problems that may be encountered during actual use of equipment and raise questions for the student to answer. Case studies are included as boxes throughout the chapters within boxes and Clinical Rounds. Historical Notes provide educationally or clinically relevant information. Chapters featuring topics such as methods to improve ventilation, frequently used pharmacologic agents in ventilated patients, cardiovascular complications, pulmonary complications, noninvasive positive pressure ventilation, and long-term ventilation have been added. Key Point boxes have been placed sporadically throughout the chapters and highlight key information for the reader. Increased number of NBRC-type questions reflecting the types of questions and amount of coverage on the board exams. Respected educator J.M. Cairo has been added as co-author, bringing in a fresh voice and a wide breadth of experience. A reorganization of chapters creates a text that is more in line with the way the course is typically taught. lAll chapters have been heavily revised and updated, particularly the chapters on ventilator graphics, methods to improve oxygenation, and neonatal and pediatric ventilation. A second color has been added to enhance the overall design and line drawings. Key terms are listed at the beginning of each chapter and highlighted at first mention.

Abbreviations
Basic Concepts and Core Knowledge in Mechanical Ventilation
Oxygenation and Acid-Base Evaluation
Review of Arterial Blood Gases
Evaluating Oxygenation
Evaluating the Transfer and Uptake of Oxygen from the Alveoli-P(A-a)O[subscript 2], PaO[subscript 2]/P[subscript A]O[subscript 2], and PaCO[subscript 2]/F[subscript 1]O[subscript 2]
Changes in Alveolar Ventilation Associated with Changes in P[subscript A]O[subscript 2] and P[subscript A]CO[subscript 2]
Alveolar Ventilation, PaCO[subscript 2], and VCO[subscript 2]
Changes in pH, PaCO[subscript 2], and Sodium Bicarbonate
Changes in pH caused by Changes in PaCO[subscript 2]
Changes in Plasma Bicarbonate Caused by Changes in PaCO[subscript 2]
Metabolic Changes in Bicarbonate and pH
Basic Terms and Concepts of Mechanical Ventilation
Physiological Terms and Concepts Related to Mechanical Ventilation
Normal Mechanics of Spontaneous Ventilation
Lung Characteristics
Time Constants
Types of Ventilators and Terms Applied to Mechanical Ventilation
Types of Mechanical Ventilation
Definition of Pressures in Positive Pressure Ventilation
How Ventilators Work
Historical Perspective on Ventilator Classification
Internal Function
Power Source or Input Power
Control Systems and Circuits
Power Transmission and Conversion System
How a Breath Is Delivered
Basic Model of Ventilation in the Lung during Inspiration
Factors Controlled and Measured by the Ventilator during Inspiration
Overview of Inspiratory Waveform Control
Four Phases of a Breath and Phase Variables
Beginning of Inspiration: The Trigger Variable
Inspiratory Factors: The Limit Variable
Termination of the Inspiratory Phase: The Cycling Mechanism (Cycle Variable)
Types of Breaths
Expiratory Phase: The Baseline Variable
Initiating Ventilation
Establishing the Need for Mechanical Ventilation
Acute Respiratory Failure
Patient History and Diagnosis
Physiological Measurements in Acute Respiratory Failure
Overview of Criteria for Mechanical Ventilation
Possible Alternatives to Invasive Ventilation
Patient Cases
Selecting the Ventilator and the Mode
Invasive or Noninvasive Ventilation: Selecting the Patient Interface
Methods of Noninvasive Support and Appropriate Patient Interfaces
Full and Partial Ventilatory Support
Mode of Ventilation and Breath Delivery
Type of Breath Delivery
Targeting Volume as the Control Variable
Targeting Pressure as the Control Variable
Breath Delivery and Modes of Ventilation
Bilevel Positive Airway Pressure
Closed Loop Ventilation
Less Frequently Used Closed Loop Modes of Ventilation
Initial Ventilator Settings
Determining Initial Ventilator Setting during Volume Ventilation
Initial Settings during Volume Ventilation
Setting Minute Ventilation
Tidal Volume and Rate
Relationship of Tidal Volume, Flow, Total Cycle Time, and Inspiratory to Expiratory Ratio
Inspiratory Flow and Flow Patterns
Setting the Minute Ventilation: Special Considerations
Inspiratory Pause during Volume Ventilation
Actual Clinical Examples of Ventilator Adjustment
Determining Initial Ventilator Settings during Pressure Ventilation
Setting Baseline Pressure-Physiological PEEP
Determining Tidal Volume Delivery in Pressure Ventilation
Initial Settings for Pressure Support Ventilation
Initial Settings for Pressure Control Ventilation
Initial Settings for Bilevel Positive Airway Pressure Ventilation
Initial Settings for Dual Control Pressure Ventilation Modes with Volume Targeting
Final Considerations in Ventilator Setup
Selection of Additional Parameters and Final Ventilator Setup
Selection of Fractional Inspired O[subscript 2]
Sensitivity Setting
Humidification
Alarms
Action during Ventilator Alarm Situations
Periodic Hyperinflation or Sighing
Final Considerations in Ventilator Equipment Setup
Selecting the Appropriate Ventilator
Evaluation of Ventilator Performance
Initial Ventilator Settings for Specific Patient Situations
Chronic Obstructive Pulmonary Disease
Neuromuscular Disorders
Asthma
Closed Head Injury
Adult Respiratory Distress Syndrome
Acute Cardiogenic Pulmonary Edema and Congestive Heart Failure
Monitoring in Mechanical Ventilation
Initial Assessment of the Mechanically Ventilated Patient
Documentation of the Patient-Ventilator System
The First 30 Minutes
Monitoring Airway Pressures
Vital Signs, Blood Pressure, and Physical Examination of the Chest
Management of Endotracheal and Tracheostomy Tube Cuffs
Monitoring Compliance and Airway Resistance
Comment Section of the Ventilator Flow Sheet
Ventilator Graphics
Relationship of Pressure, Volume, Flow, and Time
Volume Ventilation with Constant Flow
Producing Ventilator Graphics
Calculations
A Closer Look at the Flow-Time Scalar in VC-CMV
Changes in the Pressure-Time Curve
Volume Scalar
Key Points of Volume Ventilation Graphics
Pressure Ventilation
Pressure Ventilation with a Constant Pressure Waveform
Key Points of Pressure Ventilation Graphics
Pressure Support Ventilation
Details of the Pressure-Time Waveform in PSV
Flow Cycling during PSV
Automatic Adjustment of the Flow-Cycle Criterion
Use of PSV with SIMV
Pressure-Volume Loops
Components of the P-V Loop
P-V Loop and WOB
Troubleshooting a P-V Loop
Flow-Volume Loops during Mechanical Ventilation
Components of an F-V Loop with Mandatory Breaths
Troubleshooting with F-V Loops during Mechanical Ventilation
Noninvasive Assessment of Respiratory Function
Noninvasive Measurement of Blood Gases
Pulse Oximetry
Capnography and Capnometry
Transcutaneous Monitoring
Indirect Calorimetry and Metabolic Measurements
Overview of Indirect Calorimetry
Technical Aspects
Assessment of Respiratory System Mechanics
Airway Pressure Measurements
Flow Measurements
Clinical Applications
Hemodynamic Monitoring
Review of Cardiovascular Principles
Obtaining Hemodynamic Measurements
Interpretation of Hemodynamic Profiles
Clinical Applications
Therapeutic Interventions-Making Appropriate Changes
Methods to Improve Ventilation and Other Techniques in Patient-Ventilator Management
Correcting PaCO[subscript 2] Abnormalities
Common Methods of Changing Ventilation Based on PaCO[subscript 2] and pH
Metabolic Acidosis and Alkalosis
Mixed Acid-Base Disturbances
Increased Physiological Dead Space
Increased Metabolism and Increased CO[subscript 2] Production
Intentional latrogenic Hyperventilation
Permissive Hypercapnia
Airway Clearance during Mechanical Ventilation
Secretion Clearance from an Artificial Airway
Administering Aerosols to Ventilated Patients
Chest Physiotherapy in Mechanically Ventilated Patients
Flexible Fiberoptic Bronchoscopy during Mechanical Ventilation
Additional Patient Management Techniques and Therapies in Ventilated Patients
Importance of Body Position and Positive Pressure Ventilation
Ventilator Circuit Changes
Sputum and Upper Airway Infections
Fluid Balance
Psychological and Sleep Status
Patient Comfort and Safety
Transport of Mechanically Ventilated Patients within an Acute Care Facility
Improving Oxygenation and Management of ARDS
Basics of Oxygenation Using F[subscript 1]O[subscript 2], PEEP studies, and Pressure-Volume Curves for Establishing Optimum PEEP
Basics of Oxygen Delivery to the Tissues
Introduction to Positive End-Expiratory Pressure and Continuous Positive Airway Pressure
PEEP Ranges
Indications for PEEP/CPAR
Initiating PEEP Therapy
Selecting the Appropriate PEEP/CPAP Level (Optimum PEEP)
Use of Pulmonary Vascular Pressure Monitoring with PEEP
Pressure-Volume Loops in Setting PEEP
Contraindications and Physiological Effects of PEEP
Contraindications for PEEP
Pulmonary Effects of PEEP
Transmission of Airway Pressure to Pleural Space
Uses of PEEP for Problems Other than Acute Lung Injury
Weaning from PEEP
Acute Respiratory Distress Syndrome
Definition and Epidemiology
Pathophysiology
Changes in Computed Tomogram with ARDS
ARDS as an Inflammatory Process
PEEP and the Vertical Gradient in ARDS
Lung Protective Strategies: Setting Tidal Volume and Pressures in ARDS
Long-Term Follow-Up on ARDS
Recruitment Maneuvers in ARDS
Illustration of a Recruitment Maneuver
The Function of Lung Recruitment
Hazards of Recruitment Maneuvers
Variability among Patients
Effects of Chest Wall Compliance on Lung Recruitment
Patient Evaluation for Lung Recruitment
Types of Recruitment Maneuvers
Summary of Recruitment Maneuvers in ARDS
Patient Cases
Case Study: Adult Respiratory Distress Syndrome
Case Study: Congestive Heart Failure
Frequently Used Pharmacological Agents in Ventilated Patients: Sedatives, Analgesics, and Paralytics
Sedatives and Analgesics
Paralytics
Effects and Complications of Mechanical Ventilation
Effects of Positive Pressure Ventilation on the Cardiovascular, Cerebral, Renal, and Other Organ Systems
Effects of Positive Pressure Ventilation on the Heart and Thoracic Vessels
Adverse Cardiovascular Effects of PPV
Factors Influencing Cardiovascular Effects of PPV
Beneficial Effects of PPV on Heart Function in Patients with Left Ventricular Dysfunction
Minimizing the Physiological Effects and Complications of Mechanical Ventilation
Effects of Mechanical Ventilation on Intracranial Pressure, Renal Function, Liver Function, and Gastrointestinal Function
Effects of Mechanical Ventilation on Intracranial Pressure and Cerebral Perfusion
Renal Effects of Mechanical Ventilation
Effects of Mechanical Ventilation on Liver and Gastrointestinal Function
Nutritional Complications during Mechanical Ventilation
Effects of Positive Pressure Ventilation on the Pulmonary System
Lung Injury with Mechanical Ventilation
Effects of Mechanical Ventilation on Gas Distribution and Pulmonary Blood Flow
Nosocomial Infections and Ventilator-Associated Pneumonia
Respiratory and Metabolic Acid-Base Status in Mechanical Ventilation
Air Trapping (Auto-PEEP)
Hazards of Oxygen Therapy with Mechanical Ventilation
Increased Work of Breathing
Ventilator Mechanical and Operational Hazards
Complications of the Artificial Airway
Troubleshooting and Problem Solving
Definition of the Term Problem
Solving Ventilation Problems
Protecting the Patient
Identifying the Patient in Sudden Distress
Patient-Related Problems
Ventilator-Related Problems
Common Alarm Situations
Use of Graphics to Identify Ventilator Problems
Unexpected Ventilator Responses
Noninvasive Positive Pressure Ventilation
Basic Concepts of Noninvasive Positive Pressure Ventilation
Noninvasive Ventilation Techniques
Goals and Indications for NPPV
Patient Selection Criteria
Equipment Selection for NPPV
Setup and Preparation for NPPV
Monitoring and Adjustment of NPPV
Complications of NPPV
Patient Weaning and Discontinuation of NPPV
Patient Care Team Concerns
Discontinuation from Ventilation and Long-Term Ventilation
Discontinuation of and Weaning from Mechanical Ventilation
Weaning Techniques
Methods of Titrating Ventilator Support during Weaning
Closed Loop Modes for Ventilator Discontinuation
Evidence-Based Weaning
Evaluation of Clinical Criteria for Weaning
Pathology of Ventilator Dependence
Assessment of Readiness for Weaning Using Evaluation Criteria
Assessment during a Spontaneous Breathing Trial
Removal of the Artificial Airway
Factors in Weaning Failure
SBT Failure
Nonrespiratory Factors That May Complicate Weaning
Maintaining Ventilation in Patients with SBT Failure
Final Recommendations
Anesthesia and Sedation Strategies and Protocols
Weaning Protocols
Role of Tracheostomy in Weaning
Long-Term Care Facilities for Patients Requiring Prolonged Ventilation
Clinician Familiarity with Long-Term Care Facilities
Weaning in Long-Term Ventilation Units
Ethical Dilemma: Withholding and Withdrawing Ventilatory Support
Long-Term Ventilation
Goals of LTMV
Sites for Ventilator-Dependent Patients
Patient Selection
Preparation for Discharge to the Home
Follow-Up and Evaluation
Equipment Selection for Patients to Be Ventilated at Home
Complications of Long-Term Positive Pressure Ventilation
Alternatives to Invasive Mechanical Ventilation at Home
Expiratory Muscle Aids and Secretion Clearance
TTs, Speaking Valves, and Tracheal Buttons
Ancillary Equipment and Equipment Cleaning for Home Mechanical Ventilation
Special Applications of Mechanical Ventilation
Neonatal and Pediatric Mechanical Ventilation
Recognizing the Need for Mechanical Ventilatory Support
Continuous Positive Airway Pressure
Conventional Mechanical Ventilation
Weaning and Extubation
High-Frequency Ventilation
Special Techniques in Ventilatory Support
Airway Pressure-Release Ventilation
Other Names
Advantages of APRV Compared with Conventional Ventilation
Disadvantages
Initial Settings for APRV
Adjusting Ventilation and Oxygenation
Discontinuing APRV
High-Frequency Oscillatory Ventilation in the Adult
Technical Aspects
Initial Control Settings for HFOV in the Adult
Indication and Exclusion Criteria for HFOV in the Adult
Monitoring, Assessment, and Adjustment of HFO
Adjusting Settings to Maintain ABG Goals
Returning to Conventional Ventilation
Heliox Therapy and Mechanical Ventilation
Gas Flow through the Airways
Heliox in Avoiding Intubation and during Mechanical Ventilation
Postextubation Stridor
Devices for Delivering Heliox in Spontaneously Breathing Patients
Manufactured Heliox Delivery System
Heliox and Aerosol Delivery during Mechanical Ventilation
Heliox with a Mechanical Ventilator
Heliox and NPPV
Independent Lung Ventilation
Ventilator Procedure for ILV
Thoracoabdominal Aortic Aneurism Repair
Establishing Safe PEEP and Ventilation with a Slow Flow Inflection Maneuver for Assessment of Lung Characteristics
Establishing Mechanical Ventilation after TAAA
Recruitment Maneuvers in Postoperative Patients
Intrapulmonary Percussive Ventilation
Equipment
Administration by Mouthpiece
Administration through a Ventilator
Appendix A
Appendix B
Appendix C
Glossary

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