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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 | |