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