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دانلود کتاب Egan's Fundamentals of Respiratory Care
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Egan's Fundamentals of Respiratory Care
ویرایش: 13 نویسندگان: Albert J. Heuer, David L. Vines, Eduardo Mireles-Cabodevila, James K. Stoller, Robert L. Chatburn سری: ISBN (شابک) : 0323933394, 9780323933391 ناشر: Elsevier سال نشر: 2024 تعداد صفحات: 1519 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 22 مگابایت
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Front Cover IFC EGAN’S FUNDAMENTALS OF RESPIRATORY CARE Copyright Dedication CONTRIBUTORS PREFACE CONTENTS VIDEO CONTENTS I - Foundations of Respiratory Care 1 - Early History of Respiratory Carea DEFINITIONS HISTORY OF RESPIRATORY MEDICINE AND SCIENCE Ancient Times The Middle Ages, Renaissance, and Enlightenment Period Nineteenth and Early Twentieth Centuries DEVELOPMENT OF THE RESPIRATORY CARE PROFESSION Clinical Advances in Respiratory Care Oxygen Therapy Aerosol Medications Mechanical Ventilation Airway Management Cardiopulmonary Diagnostics and Pulmonary Function Testing PROFESSIONAL ORGANIZATIONS AND EVENTS American Association for Respiratory Care Respiratory Care Week Board of Medical Advisors American Respiratory Care Foundation International Council for Respiratory Care National Board for Respiratory Care NATIONAL BOARD FOR RESPIRATORY CARE Committee on Accreditation for Respiratory Care RESPIRATORY CARE EDUCATION REFERENCES MULTIMEDIA RESOURCES Additional Resources 2 - The Profession of Respiratory Care INTRODUCTION SCOPE OF RESPIRATORY CARE PRACTICE TODAY PRACTICE SETTINGS RESPIRATORY THERAPY DEPARTMENT COMPOSITION Department Director Educational Coordinator Quality Assurance Coordinator Researcher/Scientist Supervisors/Lead Therapists Respiratory Therapists Medical Director DESIGNATIONS AND CREDENTIALS OF RESPIRATORY THERAPISTS PROFESSIONAL RESPIRATORY CARE ORGANIZATIONS TODAY American Association for Respiratory Care Board of Directors House of Delegates Board of Medical Advisors President\'s Council National Board for Respiratory Care National Board for Respiratory Care Examinations Commission on Accreditation for Respiratory Care American Respiratory Care Foundation Coalition for Baccalaureate and Graduate Respiratory Therapy Education International Council for Respiratory Care OTHER ORGANIZATIONS AFFECTING RESPIRATORY CARE Joint Commission Centers for Medicare and Medicaid Services Association for the Advancement of Medical Instrumentation RESPIRATORY THERAPY EDUCATION Degree Advancement Programs STATE LICENSURE PROFESSIONALISM THE FUTURE OF RESPIRATORY CARE Pulmonary Disease Manager Advance Practice Respiratory Therapist REFERENCES 3 - Quality, Patient Safety, and Communication QUALITY CONSIDERATIONS What Is Quality of Medical Care? Methods of Quality Improvement Plan-Do-Study-Act Cycle Plan Phase Do Phase Study (or Check) Phase Act Phase The Plan-Do-Study-Act Cycle Starts Over Six Sigma Origin of the Term Six Sigma Lean Management The Evolution of Quality in Healthcare in the United States Disease Management Monitoring Quality in Respiratory Care Peer Review Organizations SAFETY CONSIDERATIONS Patient Movement and Ambulation Basic Body Mechanics Moving the Patient in Bed Ambulation Electrical Safety Fundamentals of Electricity Preventing Shock Hazards Ground Electrical Equipment Near the Patient Fire Hazards General Safety Concerns Direct Patient Environment Magnetic Resonance Imaging Safety Medical Gas Cylinders COMMUNICATION Communication in Healthcare Factors Affecting Communication Improving Communication Skills Practitioner as Sender Practitioner as Receiver and Listener Providing Feedback Minimizing Barriers to Communication CONFLICT AND CONFLICT RESOLUTION Sources of Conflict Ineffective Communication Structural Problems Personal Behavior Role Conflict Conflict Resolution Competing Accommodating Avoiding Collaborating Compromising REFERENCES 4 - Principles of Infection Prevention and Control SPREAD OF INFECTION Sources of Infectious Agents Susceptible Hosts Modes of Transmission Contact Transmission Respiratory Transmission STRATEGIES FOR THE PREVENTION OF INFECTION Creating a Safe Culture Maintaining a Healthy Workforce Eliminating the Source of Pathogens Interrupting Transmission Standard Precautions Hand Hygiene Gloves Mouth, Nose, Eye, and Face Protection Respiratory Protection Gowns, Aprons, and Protective Apparel Cough Etiquette and Wearing a Source Control Mask Transmission-Based Precautions Protective Environment Cystic Fibrosis Patients Transport of Infected Patients Medical Devices and Bundles DISINFECTION AND STERILIZATION The Spaulding Approach to Disinfection and Sterilization of Patient Care Equipment Cleaning Disinfection Chemical Disinfection Sterilization EQUIPMENT-HANDLING PROCEDURES Maintenance of In-Use Equipment Nebulizers Ventilators and Ventilator Circuits Bag-Mask Devices Suction Systems Oxygen Therapy Apparatus Pulmonary Function Equipment Other Respiratory Care Devices Reprocessing Reusable Equipment Respiratory Care Equipment Bronchoscope reprocessing Disposable Equipment Fluid and Medication Precautions Handling Contaminated Articles and Equipment Handling Laboratory Specimens SURVEILLANCE FOR HOSPITAL-ACQUIRED INFECTIONS REFERENCES MULTIMEDIA RESOURCES Additional Resources 5 - Ethical and Legal Implications of Practice PHILOSOPHICAL FOUNDATIONS OF ETHICS ETHICAL DILEMMAS OF PRACTICE CODES OF ETHICS ETHICAL THEORIES AND PRINCIPLES Autonomy Veracity Nonmaleficence Beneficence Confidentiality Justice Role Duty ETHICAL VIEWPOINTS AND DECISION-MAKING Formalism Consequentialism Mixed Approaches Virtue Ethics Intuitionism Comprehensive Decision-Making Models LEGAL ISSUES AFFECTING RESPIRATORY CARE Systems of Law Public (Criminal and Administrative) Law Civil Law Tort law Professional negligence Malpractice Intentional torts Strict liability Breach of contract Civil suits Helping Avoid Lawsuits Health Insurance Portability and Accountability Act of 1996 Medical Supervision Scope of Practice Basic elements of a practice act Licensure laws and regulations Providing emergency care without physician direction INTERACTION OF ETHICS AND THE LAW PROFESSIONAL LICENSURE ISSUES Licensure Statute Understanding the Causes of Discipline Engaging Counsel RESPIRATORY THERAPISTS WHO SPEAK OUT ABOUT WRONGDOING Patient Protection and Affordable Care Act National Labor Relations Act False Claims Act HEALTHCARE AND CHANGE Healthcare Advance Directives REFERENCES 6 - Physical Principles of Respiratory Care STATES OF MATTER Internal Energy of Matter Laws of Thermodynamics Heat Transfer Conduction Convection Radiation Evaporation and Condensation Temperature Absolute Zero Temperature Scales CHANGE OF STATE Liquid-Solid Phase Changes (Melting and Freezing) Melting Freezing Properties of Liquids Pressure in Liquids Buoyancy (Archimedes Principle) Viscosity Cohesion and Adhesion Surface Tension Capillary Action Liquid-Vapor Phase Changes Boiling Evaporation, Vapor Pressure, and Humidity Influence of temperature Humidity Influence of pressure Influence of surface area Properties of Gases Kinetic Activity of Gases Molar Volume and Gas Density Molar volume Density Gaseous Diffusion Gas Pressure Measuring atmospheric pressure Clinical pressure measurements Partial Pressures (Dalton\'s Law) Solubility of Gases in Liquids (Henry\'s Law) GAS BEHAVIOR UNDER CHANGING CONDITIONS Gas Laws Effect of Water Vapor Corrected Pressure Computations Correction Factors Properties of Gases at Extremes of Temperature and Pressure Critical Temperature and Pressure FLUID DYNAMICS Pressures in Flowing Fluids Patterns of Flow Laminar Flow Turbulent Flow Transitional Flow Flow, Velocity, and Cross-Sectional Area Bernoulli Principle Fluid Entrainment Fluidics and the Coanda Effect REFERENCES 7 - E-Medicine in Respiratory Care THE ELECTRONIC HEALTH RECORD AND THE ELECTRONIC MEDICAL RECORD Computerized Physician Order Entry Enterprise Software Packages APPLICATIONS FOR PATIENT CARE Applications in Diagnostics Hemodynamic Monitoring Blood Gas Laboratories and Point-of-Care Applications Medical Imaging and Picture Archiving and Communication Systems Pulmonary Function Testing and Interpretation Interpretation of Pulmonary Function Tests Applications in Treatment Applications in the Acute Care Setting Mechanical ventilators Closed-loop ventilation Therapist-driven protocols Applications in Nonacute Care Settings and Chronic Diseases Asthma Chronic obstructive pulmonary disease Applications in Disease and Infection Prevention Treatment of Tobacco Use and Dependence Education of the Public and Healthcare Consumer INFORMATICS AND CLINICAL DECISION SUPPORT Business Intelligence Clinical Decision Support Mobile Applications (m-Health) Administrative Decision Support American Association for Respiratory Care Benchmarking System Research TELEHEALTH AND TELEMONITORING SOURCES OF HEALTH INFORMATION Health Information Sources for Respiratory Therapists and Other Clinicians Health Information Sources for Consumers APPLICATIONS IN HEALTHCARE ADMINISTRATION Documentation, Workload, Staffing, and Scheduling Financial Management Quality Assurance Regulatory Compliance Web Analytics Human Resources Privacy and Confidentiality APPLICATIONS IN TRAINING AND EDUCATION Clinical Simulations Full-Scale and Other Physiologic Clinical Simulators Clinical Education Applications National Board for Respiratory Care Credentialing Learning Management Systems American Association for Respiratory Care FUTURE OF E-MEDICINE REFERENCES MULTIMEDIA RESOURCES Additional Resources 8 - Fundamentals of Respiratory Care Research OVERVIEW OF RESPIRATORY CARE RESEARCH The Importance of Research in Healthcare HOW TO REVIEW AND EVALUATE THE LITERATURE Bibliographic Databases Synthesized Databases Portals Electronic Journals and Books General Internet Resources Suggestions for Conducting Searches EVALUATING THE QUALITY OF RESEARCH Evidence-Based Medicine HOW TO BEGIN DOING RESEARCH How to Develop a Study Idea Key Roles in Research How to Write a Study Protocol How to Analyze the Data HOW TO SUBMIT A PAPER FOR PUBLICATION How to Write the Abstract How to Make a Poster How to Write a Paper How to Respond to Reviews SUMMARY REFERENCES II - Applied Anatomy and Physiology 9 - The Respiratory System DEVELOPMENT OF THE RESPIRATORY SYSTEM TRANSITION FROM UTERINE TO EXTRAUTERINE LIFE Placental Structure and Function Fetal Circulation Cardiopulmonary Events at Birth POSTNATAL LUNG DEVELOPMENT Upper Airway Lower Airway and Alveoli Development of Vascular, Lymphatic, and Nervous Systems Chest Wall Development, Diaphragm, and Lung Volume RESPIRATORY SYSTEM IN THE ADULT Surface Features of the Thorax Components of the Thoracic Wall Rib Movement Respiratory Muscles Pleural Membranes, Space, and Fluid Mediastinum Lungs ANATOMY OF THE RESPIRATORY TRACT Upper Respiratory Tract Nasal Cavity and Sinuses Oral Cavity Pharynx Larynx Speech Breath-hold, effort closure, and cough Patent Upper Airway Lower Respiratory Tract Trachea and Bronchi Lobar and Segmental Pulmonary Anatomy Histology of the Airway Wall Respiratory Zone Airways Alveoli Blood-Gas Barrier PULMONARY VASCULAR, LYMPHATIC, AND NERVOUS SYSTEMS Pulmonary Circulation Respiratory Function of Pulmonary Circulation Non-respiratory Function of the Pulmonary Circulation Bronchial Circulation Lymphatics Neural Control of the Lungs Efferent Pathways Afferent Pathways REFERENCES MULTIMEDIA RESOURCES Videos Additional Resources 10 - The Cardiovascular System FUNCTIONAL ANATOMY Heart Anatomy of the Heart Properties of the Heart Muscle Microanatomy of the Heart Muscle Vascular System Systemic Circulation Vascular Resistance Determinants of Blood Pressure CONTROL OF THE CARDIOVASCULAR SYSTEM Regulation of Peripheral Vasculature Local Control Central Control Regulation of Cardiac Output Changes in Stroke Volume Changes in Heart Rate CARDIOVASCULAR CONTROL MECHANISMS Outline placeholder Cardiovascular Control Centers Peripheral Receptors Blood Volume Regulation EVENTS OF THE CARDIAC CYCLE REFERENCES BIBLIOGRAPHY MULTIMEDIA RESOURCES Videos 11 - Ventilation MECHANICS OF VENTILATION Pressure Differences During Breathing Forces Opposing Inflation of the Lung Surface Tension Forces Elastic Forces Opposing Lung Inflation Compliance Combined Compliances Resistive Forces Opposing Lung Inflation Tissue viscous resistance Airway resistance Combined Resistances Factors affecting resistance Distribution of resistance STATIC VERSUS DYNAMIC MECHANICS MECHANICS OF EXHALATION WORK OF BREATHING Mechanical Work Metabolic Work DISTRIBUTION OF VENTILATION Regional Factors Affecting Distribution Differences in Thoracic Expansion Transpulmonary Pressure Gradients Local Factors Affecting Distribution Time Constants Frequency Dependence of Compliance EFFICIENCY AND EFFECTIVENESS OF VENTILATION Efficiency Minute Ventilation Alveolar Ventilation Anatomic Dead Space Alveolar Dead Space Physiologic Dead Space Ratio of Dead Space to Tidal Volume Effectiveness of Ventilation REFERENCES MULTIMEDIA RESOURCES Additional Resources 12 - Gas Exchange and Transport DIFFUSION Whole-Body Diffusion Gradients Determinants of Alveolar Gas Tensions Alveolar Carbon Dioxide Alveolar Oxygen Tensions Mechanism of Diffusion Barriers to Gaseous Diffusion The Fick First Law of Diffusion Pulmonary Diffusion Gradients Time Limits to Diffusion VARIATIONS FROM IDEAL GAS EXCHANGE Anatomic Shunts Inequalities in Ventilation and Perfusion Ventilation/Perfusion Ratio Effect of Alterations in Ventilation/Perfusion Ratio Dead Space Regional Differences in Ventilation/Perfusion Ratio OXYGEN TRANSPORT Chemically Combined Oxygen (Oxyhemoglobin) Hemoglobin and Oxygen Transport Hemoglobin Saturation Total Oxygen Content of the Blood Oxyhemoglobin Dissociation Curve Normal Loading and Unloading of Oxygen (Arteriovenous Differences) Factors Affecting Oxygen Loading and Unloading pH (Bohr Effect) Body Temperature Organic Phosphates (2,3-Diphosphoglycerate) Abnormal Hemoglobin CARBON DIOXIDE TRANSPORT Transport Mechanisms Dissolved in Physical Solution Chemically Combined With Protein Ionized as Bicarbonate Carbon Dioxide Dissociation Curve ABNORMALITIES OF GAS EXCHANGE AND TRANSPORT Impaired Oxygen Delivery Causes of Hypoxemia Hemoglobin deficiencies Reduction in Blood Flow (Shock or Ischemia) Circulatory failure (shock) Local reductions in perfusion (ischemia) Dysoxia Impaired Carbon Dioxide Removal Inadequate Minute Ventilation Increased Dead Space Ventilation Ventilation/Perfusion Imbalances REFERENCES MULTIMEDIA RESOURCES Videos 13 - Solutions, Body Fluids, and Electrolytes SOLUTIONS, COLLOIDS, AND SUSPENSIONS Definition of a Solution Concentration of Solutions Starling Forces Osmotic Pressure of Solutions Quantifying Solute Content and Activity Equivalent Weights Gram equivalent weight values Gram equivalent weight of an acid Gram equivalent weight of a base Conversion of gram weight to equivalent weight Milligram equivalent weights Solute Content by Weight Calculating Solute Content Quantitative Classification of Solutions Dilution Calculations ELECTROLYTIC ACTIVITY AND ACID-BASE BALANCE Characteristics of Acids, Bases, and Salts Acids Acids with single ionizable hydrogen Acids with multiple ionizable hydrogens Bases Hydroxide bases Nonhydroxide bases Ammonia Carbonates Protein bases Designation of Acidity and Alkalinity Nanomolar Concentrations pH Scale BODY FLUIDS AND ELECTROLYTES Body Water Distribution Composition Regulation Water losses Water replacement Ingestion Metabolism Transport Between Compartments Electrolytes Sodium (Na+) Chloride (Cl-) Bicarbonate (HCO3−) Potassium (K+) Calcium (Ca2+) Magnesium (Mg2+) Phosphorus REFERENCES 14 - Acid-Base Balance HYDROGEN ION REGULATION IN BODY FLUIDS Strong and Weak Acids and Bases: Equilibrium Constants Buffer Solution Characteristics Bicarbonate and Nonbicarbonate Buffer Systems pH of a Buffer System: Henderson-Hasselbalch Equation Clinical Use of Henderson-Hasselbalch Equation Physiologic Roles of Bicarbonate and Nonbicarbonate Buffer Systems Bicarbonate Buffer System Nonbicarbonate Buffer System ACID EXCRETION Lungs Kidneys Basic Kidney Function Reabsorption of Bicarbonate Ion Excess Hydrogen Ion Excretion and Role of Urinary Buffers ACID-BASE DISTURBANCES Normal Acid-Base Balance Primary Respiratory Disturbances Primary Metabolic (Nonrespiratory) Disturbances Compensation: Restoring pH to Normal Effect of the Carbon Dioxide Hydration Reaction on [HCO3-] CLINICAL ACID-BASE STATES Systematic Acid-Base Classification Step 1: Categorize pH Step 2: Determine Respiratory Involvement Step 3: Determine Metabolic (Nonrespiratory) Involvement Step 4: Assess for Compensation Respiratory Acidosis Causes Compensation Correction Respiratory Alkalosis Causes Clinical Signs Compensation Correction Alveolar Hyperventilation Superimposed on Compensated Respiratory Acidosis Metabolic (Nonrespiratory) Acidosis Causes Anion Gap Compensation Symptoms Correction Metabolic Alkalosis Causes Compensation Correction Metabolic Acid-Base Indicators Standard Bicarbonate Base Excess Mixed Acid-Base States REFERENCES MULTIMEDIA RESOURCES Videos 15 - Regulation of Breathing MEDULLARY RESPIRATORY CENTER Dorsal Respiratory Groups Ventral Respiratory Groups Inspiratory Ramp Signal PONTINE RESPIRATORY CENTERS Apneustic Center Pneumotaxic Center REFLEX CONTROL OF BREATHING Hering-Breuer Inflation Reflex Deflation Reflex Head Paradoxical Reflex Irritant Receptors J-Receptors Peripheral Proprioceptors Muscle Spindles CHEMICAL CONTROL OF BREATHING Central Chemoreceptors Peripheral Chemoreceptors Response to Decreased Arterial Oxygen Response to Increased PaCO2 and Hydrogen Ions Control of Breathing in Chronic Hypercapnia Oxygen-Associated Hypercapnia Central Chemoreceptor Response to Acute Carbon Dioxide Increase in Chronic Hypercapnia VENTILATORY RESPONSE TO EXERCISE CARBON DIOXIDE AND CEREBRAL BLOOD FLOW REFERENCES III - Assessment of Respiratory Disorders 16 - Bedside Assessment of the Patient INTERVIEWING THE PATIENT, OBTAINING A MEDICAL HISTORY, AND REVIEWING THE MEDICAL RECORD Principles of Interviewing Structure and Technique for Interviewing Common Cardiopulmonary Symptoms Dyspnea Breathlessness Positional dyspnea Language of dyspnea Assessing dyspnea in the interview Psychogenic dyspnea: panic disorders and hyperventilation Cough Sputum Production Hemoptysis Chest Pain Pedal Edema The Medical Record and Medical History PHYSICAL EXAMINATION General Appearance Level of Consciousness Vital Signs Body Temperature Pulse Rate Respiratory Rate Arterial Blood Pressure Examination of the Head and Neck Head Neck Examination of the Thorax and Lungs Inspection Thoracic configuration Thoracic expansion Breathing pattern and effort Assessing the diaphragm Palpation Vocal and tactile fremitus Skin and subcutaneous tissues Percussion of the Chest Percussion over lung fields Clinical implications Auscultation of the Lungs Stethoscope Technique Normal lung sound terminology Lung Sounds in Pulmonary Disease Mechanisms and significance of lung sounds Diminished breath sounds Wheezes and stridor Crackles Pleural friction rub Voice sounds Cardiac Examination Inspection and Palpation Auscultation of Heart Sounds Abnormal Heart Sounds Abdominal Examination Examination of the Extremities Clubbing Cyanosis Pedal Edema Capillary Refill Peripheral Skin Temperature REFERENCES BIBLIOGRAPHY MULTIMEDIA RESOURCES Videos Additional Resources 17 - Interpreting Clinical and Laboratory Data INTERPRETING CLINICAL LABORATORY TESTS Introduction to Laboratory Medicine Reference Range Critical Test Value Complete Blood Count White Blood Cell Count Red Blood Cell Count Electrolyte Tests Basic Concepts for Understanding Electrolyte Balance Basic Chemistry Panel Glucose Anion Gap Lactate Enzyme Tests Liver Function Tests Pancreatic and Muscle Enzyme Tests Cardiac Enzyme and Protein Tests Coagulation Studies Infection Monitoring MICROBIOLOGY TESTS Sputum Gram Stain Sputum Culture Sputum Testing for Mycobacterium Tuberculosis VIRAL TESTING Sweat Test CLINICAL APPLICATION OF LABORATORY DATA Coagulation Disorders Electrolyte Disorders and Conclusion REFERENCES 18 - Interpreting the Electrocardiogram BASIC PRINCIPLES OF ELECTROPHYSIOLOGY Impulse-Conducting System ELECTROCARDIOGRAM PROCEDURAL SUMMARY Basic Electrocardiographic Waves Electrocardiographic Measurements Interpreting the Electrocardiogram Steps to Follow Axis Evaluation Recognizing Arrhythmias Normal sinus rhythm Sinus tachycardia Sinus bradycardia Sinus arrhythmia First-degree heart block Second-degree heart block Third-degree heart block Atrial flutter Atrial fibrillation Premature ventricular contractions Ventricular tachycardia Ventricular fibrillation Pulseless Electrical Activity Common Arrhythmias, Features, Causes, and Treatment Wearables and Remote Monitoring REFERENCES MULTIMEDIA RESOURCES Videos 19 - Analysis and Monitoring of Gas Exchange INVASIVE VERSUS NONINVASIVE PROCEDURES MONITORING FRACTIONAL INSPIRED OXYGEN Instrumentation Procedure Problem Solving and Troubleshooting Sampling Blood Gases Arterial Puncture and Interpretation Equipment Procedure Indications for blood gas sampling Problem solving and troubleshooting Obtaining a good sample Pre-analytic error Interpretation of arterial blood gases Indwelling Catheters (Arterial Pressure, Central Venous Pressure, and Pulmonary Artery Lines) Equipment Procedure Problem solving and troubleshooting Capillary Blood Gases Equipment Procedure Problem solving and troubleshooting Analyzing Blood Gas Samples Instrumentation Procedure Quality Assurance Record keeping Performance validation Preventive maintenance and function checks Automated calibration Internal statistical quality control External quality control (proficiency testing) Remedial action Point-of-Care Testing Instrumentation Clinical performance BLOOD GAS MONITORING Transcutaneous Blood Gas Monitoring Instrumentation Procedure Problem Solving and Troubleshooting Direct Measurement of Tissue Oxygen Instrumentation OXIMETRY Methemoglobin Carboxyhemoglobin Hemoximetry Instrumentation Procedure and Quality Assurance Problem Solving and Troubleshooting Pulse Oximetry Instrumentation Procedure Problem Solving and Troubleshooting Venous Oximetry Instrumentation Clinical Usefulness Noninvasive Tissue Oximetry Instrumentation CAPNOMETRY AND CAPNOGRAPHY Indications Instrumentation Normal Capnogram Abnormal Capnogram Procedure Problem Solving and Troubleshooting REFERENCES MULTIMEDIA RESOURCES Videos 20 - Pulmonary Function Testing PULMONARY FUNCTION TESTING Purposes Pathophysiologic Patterns Infection Control Equipment Grading of Quality REFERENCE VALUES AND INTERPRETATION OF RESULTS PRINCIPLES OF MEASUREMENT AND SIGNIFICANCE INDIVIDUAL TESTS AND MEASUREMENTS Spirometry Forced Vital Capacity Forced Expiratory Volume in 1 Second Peak Expiratory Flow Maximal Voluntary Ventilation Other values obtained during spirometry Interpretation Reversibility of Airway Obstruction Bronchoprovocation Lung Volumes and Capacities Values Measured During Spirometry Values Not Measured During Spirometry Helium Dilution Nitrogen Washout Plethysmography Interpretation Normal values for lung volumes Diffusing Capacity Single-Breath Technique Interpretation INTERPRETATION OF THE PULMONARY FUNCTION REPORT Sample Pulmonary Function Test Reports and Interpretation Solution 2 Solution Report 3 Solution Report 4 REFERENCES MULTIMEDIA RESOURCES Additional Resources 21 - Review of Thoracic Imaging OVERVIEW OF THE CHEST X-RAY Approach to Reading a Plain Chest X-Ray Chest X-Ray Technique and Quality Anatomic Structures Seen on a Chest X-Ray Advanced Chest Imaging Techniques Computed Tomography of the Chest Computed Tomography Angiography Three-Dimensional Reconstruction Magnetic Resonance Imaging of the Chest Ultrasound Nuclear Medicine PLEURA Pleural Effusion Ultrasound for Evaluating Pleural Fluid Computed Tomography Pneumothorax LUNG PARENCHYMA Alveolar Disease Pulmonary Edema Interstitial Disease Assessing Lung Volume Solitary Pulmonary Nodule MEDIASTINUM Pneumomediastinum Catheters, Lines, and Tubes Endotracheal Tube Tracheostomy Tube Central Line Peripherally Inserted Central Venous Catheter Pulmonary Artery (Swan-Ganz) Catheter Chest Tube Intra-Aortic Balloon Pump REFERENCES MULTIMEDIA RESOURCES Additional Resources 22 - Flexible Bronchoscopy and the Respiratory Therapist RIGID BRONCHOSCOPY FLEXIBLE BRONCHOSCOPY Procedure, Sedation, and Monitoring DIAGNOSTIC BRONCHOSCOPY Bronchoalveolar Lavage Bronchoalveolar Lavage Technique Bronchial Washings Bronchial Brushings Endobronchial Biopsy Transbronchial Biopsy Transbronchial Needle Aspiration: Conventional and Ultrasound-Guided Procedures Electromagnetic Navigational Bronchoscopy Ultrathin Bronchoscopy Narrow-Band Imaging THERAPEUTIC BRONCHOSCOPY Thermal Ablation of the Endobronchial Lesion Cryotherapy Endobronchial Stents Bronchial Thermoplasty Bronchoscopic Lung Volume Reduction Bronchoscopy in Difficult Intubation THE ROLE OF THE RESPIRATORY THERAPIST IN BRONCHOSCOPY SPECIAL CONSIDERATIONS FOR BRONCHOSCOPY DURING MECHANICAL VENTILATION PHYSIOLOGIC AND MECHANICAL ALTERATIONS ASSOCIATED WITH FLEXIBLE BRONCHOSCOPY IN INTUBATED PATIENTS CONCLUSION REFERENCES MULTIMEDIA RESOURCES Videos Additional Resources 23 - Nutrition Assessment NUTRITION ASSESSMENT Food-Related and Nutrition-Related History Evaluation of Nutrition History Anthropometrics Height and Weight Body mass index Overweight and obesity Kwashiorkor and marasmus Body Composition Skinfold Arm muscle area Waist circumference Biochemical Indicators Albumin Transthyretin and Retinol-Binding Protein Biomarkers of Inflammation Other Tests and Procedures Creatinine-Height Index Nitrogen Balance (Protein Catabolism) Immune Status Pulmonary Function Nutrition-Focused Physical Findings OUTCOMES OF NUTRITION ASSESSMENT MACRONUTRIENTS AND ENERGY REQUIREMENTS Estimating Energy Requirements Indirect Calorimetry Equipment and Technique Problems and Limitations Interpretation and Use of Results Alternative Resting Energy Expenditure Measures GENERAL ASPECTS OF NUTRITION SUPPORT Meeting Overall Energy Needs Insufficient Energy Consumed Protein-Energy Malnutrition Micronutrient Malnutrition Respiratory Consequences of Malnutrition Providing the Appropriate Combination of Substrates Protein Carbohydrate Fat ROUTES OF ADMINISTRATION Enteral Feeding Enteral Tube Routes Tube Feeding Administration Enteral Formula Selection Complications of Enteral Therapy Parenteral Nutrition Support NUTRITION SUPPORT IN SPECIFIC CIRCUMSTANCES General Guidelines for Critically Ill Patients Systemic Inflammatory Response Syndrome Mechanical Ventilation Chronic Obstructive Pulmonary Disease Asthma Cystic Fibrosis REFERENCES MULTIMEDIA RESOURCES Additional Resources IV - Review of Cardiopulmonary Disease 24 - Pneumonia INTRODUCTION DEFINITIONS PATHOGENESIS Mechanisms Aspiration Inhalation Contiguous Spread Hematogenous Dissemination Overgrowth of Normal Flora HOST-PATHOGEN INTERACTION CLINICAL MANIFESTATIONS IMAGING COMMUNITY-ACQUIRED PNEUMONIA Epidemiology Microbiology LABORATORY DIAGNOSIS SITE-OF-CARE DECISION THERAPIES ADJUNCTIVE THERAPIES PREVENTION OF COMMUNITY-ACQUIRED PNEUMONIA HOSPITAL-ACQUIRED PNEUMONIA\\VENTILATOR-ASSOCIATED PNEUMONIA Epidemiology Microbiology Laboratory Diagnosis THERAPIES Empiric and Specific Antibiotic Therapies ADJUNCTIVE THERAPIES Prevention of NVHAP/VAP ROLE OF THE RESPIRATORY THERAPIST IN PNEUMONIA CARE REFERENCES MULTIMEDIA RESOURCES Additional Resources 25 - Obstructive Lung Disease: Chronic Obstructive Pulmonary Disease (COPD), Asthma, and Related Diseases CHRONIC OBSTRUCTIVE PULMONARY DISEASE Overview and Definitions Epidemiology Risk Factors and Pathophysiology Clinical Signs and Symptoms Management Establishing the Diagnosis Optimizing Lung Function Stable Chronic Obstructive Pulmonary Disease Maximizing Functional Status Acute Exacerbation of Chronic Obstructive Pulmonary Disease Preventing Progression of Chronic Obstructive Pulmonary Disease and Acute Exacerbations, and Enhancing Survival Additional Therapies ASTHMA Definition Epidemiology Etiology and Pathogenesis Clinical Presentation and Diagnosis Management Objective Measurement and Monitoring Pharmacotherapy Biologic Therapy Anti-Immunoglobulin E Therapy Anti-Interleukin-5 Therapy Emergency Department and Hospital Management of Asthma Bronchial Thermoplasty Immunotherapy Environmental Control Patient Education Special Considerations in Asthma Management BRONCHIECTASIS Clinical Presentation Evaluation Management ROLE OF THE RESPIRATORY THERAPIST IN OBSTRUCTIVE LUNG DISEASE REFERENCES MULTIMEDIA RESOURCES Additional Resources 26 - Interstitial Lung Disease CHARACTERISTICS OF INTERSTITIAL LUNG DISEASE Clinical Signs and Symptoms Physical Examination Radiographic Features Physiologic Features SELECTED SPECIFIC TYPES OF INTERSTITIAL LUNG DISEASE AND THERAPIES Exposure-Related Disease Tobacco-Associated Lung Disease Drug-Related and Radiation-Related Diseases Hypersensitivity Pneumonitis Occupational Disease Interstitial Lung Disease Associated With a Systemic Disease Connective Tissue Disease Sarcoidosis Lymphangioleiomyomatosis Interstitial Lung Disease of Unknown Cause Idiopathic Interstitial Pneumonias Idiopathic pulmonary fibrosis. Nonspecific interstitial pneumonia Organizing pneumonia. Lymphocytic Interstitial Pneumonia NONSPECIFIC THERAPIES SUMMARY ROLE OF THE RESPIRATORY THERAPIST IN INTERSTITIAL LUNG DISEASE REFERENCES MULTIMEDIA RESOURCES Videos Additional Resources 27 - Pleural Diseases THE PLEURAL SPACE PLEURAL EFFUSIONS Transudative Effusions Congestive Heart Failure Hypoalbuminemia and Nephrotic Syndrome Liver Disease Atelectasis Lymphatic Obstruction Rare Causes of Transudative Pleural Effusion Exudative Effusions Parapneumonic Effusion Viral Pleuritis Tuberculosis Malignant Postoperative Effusion Chylothorax Hemothorax Connective Tissue Diseases Miscellaneous Causes Fibrothorax Physiologic Importance Mechanics of Ventilation Hypoxemia Diagnostic Tests for a Pleural Effusion Chest Radiography Ultrasonography and Computed Tomography Thoracentesis Therapy for a Pleural Effusion Therapeutic Thoracentesis Chest Thoracotomy Tubes Chest Tube Drainage Systems Thoracoscopy Pleurodesis Indwelling Pleural Catheter PNEUMOTHORAX Traumatic Blunt and Penetrating Chest Trauma Iatrogenic Neonatal Spontaneous Primary Spontaneous Pneumothorax Secondary Catamenial Pneumothorax Ventilator-Induced Lung Injury Complications of Pneumothorax Tension Pneumothorax Re-Expansion Pulmonary Edema Diagnosis of a Pneumothorax Therapy for a Pneumothorax Oxygen Observation Simple Aspiration Chest Tubes Small-bore chest tube Large-bore chest tube Bronchopleural Fistula Pleurodesis ROLE OF THE RESPIRATORY THERAPIST IN PLEURAL DISEASES REFERENCES MULTIMEDIA RESOURCES Videos 28 - Pulmonary Vascular Disease VENOUS THROMBOEMBOLIC DISEASE Pathogenesis Pathology Pathophysiology Clinical Features Chest X-Ray Electrocardiogram Arterial Blood Gases Diagnostic Modalities Pretest Risk Assessment D-Dimer Testing Testing for Lower Extremity Deep Venous Thrombosis Testing for Pulmonary Embolism Risk Assessment Treatment Prophylaxis Management of Venous Thromboembolism-Anticoagulation Management of Deep Venous Thrombosis Management of Pulmonary Embolism Prognosis Pulmonary Embolism Response Teams PULMONARY HYPERTENSION Pathogenesis Epidemiology and Clinical Findings Diagnosis Management of Pulmonary Hypertension General Measures Calcium Channel Blockers Prostacyclin Analogues and Prostacyclin Receptor Agonists Endothelin-Receptor Antagonists Phosphodiesterase-5 Inhibitors Soluble Guanylate Cyclase Stimulators Interventional Therapy Balloon Atrial Septostomy and Potts Shunt Mechanical Circulatory Support and Lung Transplantation Pulmonary Hypertension Associated With Lung Disease or Hypoxia ROLE OF THE RESPIRATORY THERAPIST IN PULMONARY VASCULAR DISEASE REFERENCES MULTIMEDIA RESOURCES Videos Additional Resources 29 - Acute Respiratory Distress Syndrome PHYSIOLOGY OF PULMONARY EDEMA Liquid and Solute Transport in the Lungs Hydrostatic Versus Non-Hydrostatic Edema Hydrostatic Pulmonary Edema Non-Hydrostatic Pulmonary Edema Gas Exchange and Lung Mechanics in Pulmonary Edema DEFINITION AND DIAGNOSIS Criteria for Clinical Syndrome Distinguishing Acute Respiratory Distress Syndrome From Hydrostatic Pulmonary Edema in Clinical Practice Pathophysiology and Histopathologic Findings of Acute Respiratory Distress Syndrome RISK FACTORS AND EPIDEMIOLOGY Risk Factors (Triggers) and Host Susceptibility Epidemiology and Outcomes MANAGEMENT Mechanical Ventilation Setting Tidal Volume Managing Airway Pressures Positive End-Expiratory Pressure Plateau Pressures Driving Pressure Mode of Mechanical Ventilation Respiratory Rate and Inspiratory Time Oxygen Titration Noninvasive Approaches to Ventilatory Support Adjunctive Strategies to Improve Lung Function Prone Positioning Neuromuscular Blockade Inhaled Vasodilators Corticosteroids Exogenous Surfactant Administration Alternative and Rescue Ventilation Strategies Airway Pressure Release Ventilation High-Frequency Ventilation Extracorporeal Support Nonventilatory Supportive Care Conservative Fluid Management Sedation and Analgesia Nutrition Mobility ROLE OF THE RESPIRATORY THERAPIST IN ACUTE RESPIRATORY DISTRESS SYNDROME REFERENCES MULTIMEDIA RESOURCES Additional Resources 30 - Respiratory Management of Trauma, Obesity, Near Drowning, and Burns LIFE-THREATENING TRAUMA Epidemiology TRAUMA AND THE ROLE OF THE RESPIRATORY THERAPIST Clinical Assessment and Specific Pathophysiologic Concerns Head, Neck, and Upper Airway Injuries Lower Respiratory Injuries Special Considerations in Patients With Chest Trauma Respiratory Management OBESITY Epidemiology Specific Pathophysiologic Concerns Clinical Assessment Respiratory Management Oxygen Therapy Aerosolized Pharmacology Noninvasive Ventilation Invasive Mechanical Ventilation Intubation Modes and minute ventilation Lung recruitment and positive end expiratory pressure Positioning Ventilator discontinuation NEAR DROWNING Epidemiology Specific Pathophysiologic Concerns Respiratory Management Airway Clearance Therapy Mechanical Ventilation Positioning BURNS Epidemiology Clinical Assessment Pathophysiology of Burn Patients Specific Concerns Respiratory Management Oxygen Therapy Early Endotracheal Intubation Secretion Management Flexible Bronchoscopy Active Humidification Mechanical Ventilation REFERENCES Trauma Obesity Drowning Burns MULTIMEDIA RESOURCES Videos 31 - Acute Heart Failure DEFINITION, EPIDEMIOLOGY, AND BURDEN OF CARE PATHOPHYSIOLOGY OF ACUTE HEART FAILURE APPROACH TO PATIENTS WITH ACUTE HEART FAILURE DIAGNOSIS OF ACUTE HEART FAILURE History and Physical Initial Laboratory Testing Imaging Electrocardiography Echocardiography Coronary Angiography Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging Lung Imaging IDENTIFYING THE CAUSE OF ACUTE HEART FAILURE MONITORING IN ACUTE HEART FAILURE TREATMENT FOR HEART FAILURE Pharmacotherapy Renin-Angiotensin System Inhibitors β-Blockers Mineralocorticoid Receptor Antagonists (MRAs) Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2Is) Hydralazine and Isosorbide Dinitrate Intravenous Vasodilators Diuretics Vasopressors and Inotropes Other Drugs and Common Combinations of Drugs Antiarrhythmic Treatment Anticoagulation Nonpharmacologic Interventions for Acute Heart Failure Mechanical Circulatory Support Multidisciplinary Team Approach RESPIRATORY SUPPORT AND MONITORING DURING ACUTE HEART FAILURE Respiratory Pathophysiology of Acute Heart Failure Ventilatory Support as Part of the Treatment of Right and Left Acute Heart Failure Titration of Ventilatory Support During Acute Heart Failure ROLE OF RESPIRATORY THERAPIST IN MANAGING ACUTE HEART FAILURE REFERENCES 32 - Lung Cancer EPIDEMIOLOGY New Cases Deaths Risk Factors Tobacco-Related Products Occupational Exposures and Other Risks Factors CLASSIFICATION PATHOPHYSIOLOGY CLINICAL FEATURES DIAGNOSIS STAGING PREOPERATIVE EVALUATION FOR LUNG RESECTION SURGERY PREVENTION Screening for Lung Cancer Tobacco Cessation TREATMENT AND OUTCOMES Non-Small Cell Lung Cancer (Table 32.3) Surgical Resection Radiotherapy (Radiation) Chemotherapy Small Cell Lung Cancer FUTURE SCENARIO ROLE OF THE RESPIRATORY THERAPIST IN MANAGING PATIENTS WITH LUNG CANCER REFERENCES MULTMEDIA RESOURCES Additional Resources 33 - Neuromuscular and Other Diseases of the Chest Wall GENERAL PRINCIPLES RELATED TO NEUROMUSCULAR WEAKNESS OF THE VENTILATORY MUSCLES Pathophysiology and Pulmonary Function Testing Clinical Signs and Symptoms Monitoring and Assessing Patients With Neuromuscular Respiratory Weakness MANAGEMENT OF VENTILATION IN RESPIRATORY MUSCLE WEAKNESS SPECIFIC NEUROMUSCULAR DISEASES Disorders of the Muscle Duchenne Muscular Dystrophy and Becker Muscular Dystrophy Myotonic Dystrophy Polymyositis and Dermatomyositis Ventilator-Induced Diaphragm Dysfunction Disorders of the Neuromuscular Junction Myasthenia Gravis Lambert-Eaton Syndrome Disorders of the Nerves Guillain-BarrE Syndrome Phrenic Nerve Dysfunction and Diaphragmatic Paralysis (Box 33.2) Disorders of the Spinal Cord Amyotrophic Lateral Sclerosis Traumatic Spinal Cord Injury Acute Brain Injury DISORDERS OF THE THORACIC CAGE Kyphoscoliosis Ankylosing Spondylitis THE ROLE OF THE RESPIRATORY THERAPIST IN CARING FOR PATIENTS WITH NEUROMUSCULAR WEAKNESS AND OTHER DISEASES OF THE CHEST WALL REFERENCES MULTIMEDIA RESOURCES Videos Additional Resources 34 - Disorders of Sleep PATHOPHYSIOLOGY Obstructive Sleep Apnea Central Sleep Apnea Overlap Syndrome Hypoventilation Syndromes CLINICAL FEATURES SCREENING QUESTIONNAIRES LABORATORY TESTING TREATMENT Behavioral Interventions and Risk Counseling Positional Therapy Medical Interventions Positive Pressure Therapy Continuous positive airway pressure therapy Bilevel positive airway pressure therapy Autotitrating devices Side effects and troubleshooting strategies for positive airway pressure therapy Oral Appliance Therapy Surgical Interventions Multilevel Surgery (MLS) Maxillofacial Surgery Upper Airway Stimulation Additional Therapies Medications ROLE OF THE RESPIRATORY THERAPIST IN DISORDERS OF SLEEP REFERENCES MULTIMEDIA RESOURCES Videos Additional Resources 35 - Neonatal and Pediatric Respiratory Disorders NEONATAL RESPIRATORY DISORDERS Lung Parenchymal Diseases Neonatal Respiratory Distress Syndrome Background Pathophysiology Clinical manifestations Management and treatment Transient Tachypnea of the Newborn Background Clinical manifestations Management and treatment Meconium Aspiration Syndrome Background Pathophysiology Clinical manifestations Management and treatment Bronchopulmonary Dysplasia Background Pathophysiology Clinical manifestations Management and Treatment Air Leak Syndromes Background Pathophysiology Management and Treatment Control of Breathing Disorders Apnea of Prematurity Background Pathophysiology Clinical manifestations Management and treatment Brief Resolved Unexplained and Apparent Life-Threatening Events (ALTE) Background and pathophysiology Clinical manifestations Management and treatment Pulmonary Vascular Disease Persistent Pulmonary Hypertension of the Newborn Background Pathophysiology Clinical manifestations Management and treatment Congenital Abnormalities Affecting Respiration Airway Diseases Tracheoesophageal fistula and esophageal atresia Tracheomalacia Lung Malformations Congenital Diaphragmatic Hernia Abdominal Wall Abnormalities Neuromuscular Control Critical Congenital Heart Disease Cyanotic Heart Diseases Tetralogy of Fallot Transposition of the great arteries Acyanotic Heart Diseases Ventricular septal defect Atrial septal defect Patent ductus arteriosus Left ventricular outflow obstructions Interrupted aortic arch Coarctation of the aorta Hypoplastic left heart syndrome OLDER INFANT AND PEDIATRIC RESPIRATORY DISORDERS Sudden Infant Death Syndrome Pathophysiology Prevention Gastroesophageal Reflux Disease Bronchiolitis Pathophysiology and Clinical Manifestations Prophylaxis Treatment Croup Clinical Manifestations Treatment Epiglottitis Pathophysiology and Clinical Manifestations Treatment and Management Cystic Fibrosis Clinical Manifestations Diagnosis Monitoring Management and Treatment Prognosis ROLE OF THE RESPIRATORY THERAPIST IN NEONATAL AND PEDIATRIC RESPIRATORY DISORDERS REFERENCES MULTIMEDIA RESOURCES Additional Resources V - Basic Therapeutics 36 - Airway Pharmacology PRINCIPLES OF PHARMACOLOGY Drug Administration Phase Pharmacokinetic Phase Pharmacodynamic Phase Airway Receptors and Neural Control of the Lung ADRENERGIC BRONCHODILATORS Indications for Use Indication for Short-Acting Agents Indication for Long-Acting Agents Indication for Racemic Epinephrine Mechanism of Action and Effects Adrenergic Bronchodilator Agents Ultrashort-Acting Catecholamines Short-Acting Noncatecholamine Agents Single-isomer β agonists Long-Acting Adrenergic Bronchodilators Adverse Effects Assessment of Bronchodilator Therapy ANTICHOLINERGIC BRONCHODILATORS Indications for Use Indication for Anticholinergic Bronchodilators Indication for Combined Anticholinergic and β-Agonist Bronchodilators Mechanism of Action Adverse Effects Assessment MUCUS-CONTROLLING AGENTS N-Acetyl Cysteine Indications for Use Mechanism of Action Side Effects Dornase Alfa Indication for Use Mechanism of Action Side Effects Other Mucoactive Agents Assessment of Mucoactive Drug Therapy Before Treatment During Treatment and in the Short Term In the Long Term General Contraindications INHALED CORTICOSTEROIDS Indications and Purposes Mechanism of Action Adverse Effects Special Considerations Assessment of Drug Therapy In the Long Term NONSTEROIDAL ANTIASTHMA DRUGS Indication for Use Mechanism of Action Adverse Effects Assessment of Drug Therapy In the Long Term AEROSOLIZED ANTIINFECTIVE AGENTS Pentamidine Isethionate Indication for Use Adverse Effects Assessment In the Long Term Ribavirin Adverse Effects Assessment Inhaled Tobramycin Adverse Effects Assessment Inhaled Aztreonam Adverse Effects Colistimethate Sodium Adverse Effects Inhaled Zanamivir Indication for Use Mechanism of Action Adverse Effects Clinical Efficacy Assessment INHALED PULMONARY VASODILATORS Nitric Oxide Indications for Use Iloprost Indications for Use Mechanism of Action Adverse Effects Treprostinil Indication for Use Mechanism of Action Adverse Effects REFERENCES MULTIMEDIA RESOURCES Additional Resources 37 - Airway Management SUCTIONING Endotracheal Suctioning Equipment and Procedure Minimizing Complications and Adverse Responses Nasotracheal Suctioning Equipment and Procedure Minimizing Complications and Adverse Responses Sputum Sampling ESTABLISHING AN ARTIFICIAL AIRWAY Routes Pharyngeal Airways Tracheal Airways Artificial Airways Endotracheal Tubes Specialized endotracheal tubes Tracheostomy Tubes Surgical Emergency Airways Procedures Orotracheal Intubation Nasotracheal Intubation Direct visualization Blind passage Tracheotomy Procedure Laryngectomy AIRWAY TRAUMA ASSOCIATED WITH TRACHEAL TUBES Laryngeal Lesions Tracheal Lesions Prevention AIRWAY MAINTENANCE Securing the Airway and Confirming Placement Providing for Patient Communication Ensuring Adequate Humidification Minimizing Nosocomial Infections Facilitating Secretion Clearance Providing Cuff Care Importance of Cuff Pressure Cuff Inflation and Measuring and Adjusting Cuff Pressure Alternative Cuff Designs Care of Tracheostomy and Tube Tracheostomy Care Changing a Tracheostomy Tube Troubleshooting Airway Emergencies Tube Obstruction Cuff Leaks Unplanned Extubation EXTUBATION OR DECANNULATION Assessing Patient Readiness for Extubation Procedures Orotracheal or Nasotracheal Tubes Tracheostomy Tube Removal (Decannulation) Fenestrated Tracheostomy Tubes Progressively Smaller Tubes Tracheal Buttons Assessment After Tracheostomy Decannulation REFERENCES MULTIMEDIA RESOURCES Video Additional Resources 38 - Emergency Cardiovascular Life Support CAUSES AND PREVENTION OF SUDDEN DEATH BASIC LIFE SUPPORT Determining Unresponsiveness Restoring Circulation Determining Pulselessness Providing Chest Compressions Adults Children Infants Neonates Chest Compressions Under Special Circumstances Near drowning Suspected opioid-related life-threatening emergency Restoring the Airway Restoring Ventilation Providing Artificial Ventilation Mouth-to-mouth ventilation Adults Infants and children Mouth-to-nose ventilation Mouth-to-stoma ventilation One-Rescuer Versus Two-Rescuer Adult Cardiopulmonary Resuscitation Automated External Defibrillation Early Defibrillation Automated External Defibrillators Evaluating the Effectiveness of Cardiopulmonary Resuscitation Hazards and Complications Neck and Spine Injuries Gastric Inflation Internal Trauma Foreign Body Airway Obstruction Contraindications to Cardiopulmonary Resuscitation Health Concerns and Cardiopulmonary Resuscitation Treating Foreign Body Airway Obstruction Abdominal Thrusts (Heimlich Maneuver) Vomiting Internal organ damage Back Blows and Chest Thrusts Evaluating the Effectiveness of Foreign Body Removal ADVANCED CARDIOVASCULAR LIFE SUPPORT Support for Oxygenation Airway Management Pharyngeal Airways Nasopharyngeal Airways Masks Endotracheal Intubation Bag-Valve-Mask Devices Design Use Hazards and Troubleshooting Restoring Cardiac Function Electrocardiogram Monitoring Supraventricular tachycardia Ventricular tachycardia Ventricular fibrillation Pulseless electrical activity Pharmacologic Intervention Routes of administration Electrical Therapy Unsynchronized countershock (defibrillation) Synchronized countershock (cardioversion) Electrical pacing Discontinuing Resuscitation Patient Care After Resuscitation Respiratory Management Cardiovascular Management REFERENCES MULTIMEDIA RESOURCES Videos 39 - Humidity and Bland Aerosol Therapy HUMIDITY THERAPY Physiologic Control of Heat and Moisture Exchange Indications for Humidification and the Warming of Inspired Gases Equipment Physical Principles Governing Humidifier Function Temperature Surface area Contact time Thermal mass Types of Humidifiers Active humidifiers Bubble humidifiers Passover humidifiers Vaporizer humidifiers Heat and moisture exchangers Active heat and moisture exchangers Heated Humidifiers Reservoir and Feed Systems Manual systems Automatic systems Setting Humidification Levels Problem Solving and Troubleshooting Condensation Cross-contamination Improper Conditioning of Inspired Gas BLAND AEROSOL THERAPY Equipment Aerosol Generators Large-volume jet nebulizers Ultrasonic nebulizers Airway Appliances Enclosures (Mist Tents and Hoods) Problem Solving and Troubleshooting Cross-contamination Environmental Exposure Inadequate Aerosol Output Overhydration Bronchospasm Noise SELECTING THE APPROPRIATE THERAPY Mechanical Ventilation Noninvasive Ventilation High-Flow High-Humidity Oxygen Therapy Sputum Induction REFERENCES 40 - Aerosol Drug Therapy CHARACTERISTICS OF THERAPEUTIC AEROSOLS Aerosol Output Particle Size Deposition Inertial Impaction Sedimentation Diffusion Aging Quantifying Aerosol Delivery HAZARDS OF AEROSOL THERAPY Infection Secondhand Exposure to Aerosol Drugs Airway Reactivity Pulmonary and Systemic Effects Eye Irritation AEROSOL DRUG DELIVERY SYSTEMS Pressurized Metered Dose Inhalers Breath-Actuated Pressurized Metered Dose Inhaler Dose Counters Factors Affecting Pressurized Metered Dose Inhaler Performance and Drug Delivery Temperature Nozzle size and cleanliness Priming Timing of actuation intervals Aerosol Delivery Characteristics Technique Pressurized Metered Dose Inhaler Accessory Devices Spacers and valved holding chambers Cost Soft Mist Inhalers Respimat Aqueous Droplet Inhaler liquid inhaler device Dry Powder Inhalers Equipment Design and Function Factors Affecting Dry Powder Inhaler Performance and Drug Delivery Intrinsic resistance and inspiratory flow Exposure to humidity and moisture Patient\'s inspiratory flow ability Technique Newer Dry Powder Inhaler Technologies Easyhaler Ellipta Podhaler Tudorza Pressair Spiromax Nebulizers Pneumatic (Jet) Nebulizers Factors affecting nebulizer performance Nebulizer design Flow Gas source (hospital versus home) Density Humidity and temperature Characteristics of drug formulation Small-Volume Nebulizers Small-volume nebulizer with a reservoir Continuous small-volume nebulizer with collection bag Breath-enhanced nebulizers Breath-actuated nebulizers Completion of nebulizer treatment Performance of SVNs Technique Infection control issues Large-Volume Jet Nebulizers Hand-Bulb Atomizers and Spray Pumps Ultrasonic Nebulizers Large-volume ultrasonic nebulizers Small-volume ultrasonic nebulizers Vibrating Mesh Nebulizers Smart Nebulizers I-neb Akita FOX Dance 501 New nebulizer designs for liquid medications InnoSpire Go Examples of nebulizers with drug-device combinations Lonhana Magnair TYVASO Cayston ALTERA eFlow Staccato Advantages and Disadvantages of Aerosol Systems Special Medication Delivery Issues for Infants and Children Selecting an Aerosol Drug Delivery System ASSESSMENT-BASED BRONCHODILATOR THERAPY PROTOCOLS Sample Protocol Assessing Patient Response Use and Limitations of Peak Flow Monitoring Other Components of Patient Assessment Dose-Response Assessment Frequency of Patient Assessment Patient Education SPECIAL CONSIDERATIONS Aerosol Therapy for Treatment of Pulmonary Arterial Hypertension Acute Care and Off-Label Use Continuous Nebulization for Refractory Bronchospasm Transnasal Pulmonary Aerosol Delivery Aerosol Administration During Ventilator Support The Effects of Humidification on Aerosol Delivery During Mechanical Ventilation Use of a Small-Volume Nebulizer During Mechanical Ventilation Use of a Vibrating Mesh Nebulizer During Mechanical Ventilation Use of a Pressurized Metered Dose Inhaler During Mechanical Ventilation Aerosol Generator Placement During Mechanical Ventilation Aerosol Administration During Noninvasive Ventilation Aerosol Administration During Intrapulmonary Percussive Ventilation or Continuous High-Frequency Oscillation Aerosol Administration During High-Frequency Oscillatory Ventilation CONTROLLING ENVIRONMENTAL CONTAMINATION Negative-Pressure Rooms Booths and Stations Personal Protective Equipment REFERENCES MULTIMEDIA RESOURCES Videos Additional Resources 41 - Storage and Delivery of Medical Gases CHARACTERISTICS OF MEDICAL GASES Oxygen Characteristics Production Fractional distillation Physical separation Air Carbon Dioxide Helium Nitric Oxide Nitrous Oxide STORAGE OF MEDICAL GASES Gas Cylinders Markings and Identification Cylinder Sizes and Contents Cylinder Safety Relief Valves Filling (Charging) Cylinders Compressed gases Liquefied gases Measuring Cylinder Contents Compressed gas cylinders Liquid gas cylinders Estimating Duration of Cylinder Gas Flow Estimating Duration of Liquid Oxygen Cylinder Gas Flow Gas Cylinder Safety Cylinder storage Cylinder transport Cylinder use Bulk Oxygen Gas Supply Systems Bulk Oxygen Safety Precautions DISTRIBUTION AND REGULATION OF MEDICAL GASES Central Piping Systems Safety Indexed Connector Systems American Standard Safety System Pin-Index Safety System Diameter-Index Safety System Quick-Connect Systems Regulating Gas Pressure and Flow High-Pressure Reducing Valves Preset reducing valve Adjustable reducing valve Multiple-stage reducing valve Proper use of high-pressure reducing valves Low-Pressure Gas Flowmeters Flow restrictor Bourdon gauge Thorpe tube REFERENCES MULTIMEDIA RESOURCES Videos 42 - Medical Gas Therapy OXYGEN THERAPY General Goals and Clinical Objectives Correcting Hypoxemia Decreasing Symptoms of Hypoxemia Minimizing Cardiopulmonary Workload Assessing the Need for Oxygen Therapy Precautions and Hazards of Supplemental Oxygen Oxygen Toxicity/Hyperoxic Acute Lung Injury Depression of Ventilation Retinopathy of Prematurity Absorption Atelectasis Fire Hazard Oxygen Delivery Systems: Design and Performance Low-Flow Systems Nasal cannula (low flow) Nasal catheter Transtracheal catheter Performance Characteristics of Low-Flow Systems Troubleshooting Low-Flow Systems Reservoir Systems Reservoir cannula Reservoir masks Troubleshooting reservoir systems High-Flow Systems Principles of gas mixing Air-entrainment systems Air-entrainment (Venturi) mask Air-entrainment nebulizer Troubleshooting air-entrainment systems Providing moderate to high FiO2 at high flow Problems with downstream flow resistance High-flow nasal cannula ROX Index Blending systems Mixing gases manually Oxygen blenders Enclosures Other Oxygen Delivery Devices Bag-mask devices Demand-flow and pulse-dose systems Selecting a Delivery System Purpose Patient Performance General Goals and Patient Categories Protocol-Based Oxygen Therapy HYPERBARIC OXYGEN THERAPY Physiologic Effects Methods of Administration Indications Air Embolism Carbon Monoxide Poisoning Complications and Hazards Troubleshooting OTHER MEDICAL GAS THERAPIES Nitric Oxide Therapy Mode of Action Indications Dosing Toxicity and Adverse Effects Methods of Administration Withdrawing Therapy Helium-Oxygen Therapy Indications Guidelines for Use Troubleshooting and Hazards Carbon Dioxide-Oxygen (Carbogen) Therapy REFERENCES MULTIMEDIA RESOURCES Additional Resources 43 - Lung Expansion Therapy CAUSES AND TYPES OF ATELECTASIS Factors Associated With Causing Atelectasis CLINICAL SIGNS OF ATELECTASIS LUNG EXPANSION THERAPY Baseline Assessment Early Mobilization of the Patient Intensive Care Unit Patient Non-Intensive Care Unit Patient Incentive Spirometry Physiologic Basis Indications Contraindications Hazards and Complications Equipment Administration Preliminary planning Implementation Follow-up Noninvasive Ventilation Intermittent Positive Airway Pressure Breathing (IPPB) Physiologic Basis Indications Contraindications Hazards and Complications Administration Preliminary planning Evaluating alternatives Discontinuation and Follow-Up Posttreatment assessment Continuous Positive Airway Pressure (CPAP) Physiologic Basis Indications Contraindications Hazards and Complications Monitoring and Troubleshooting Administration Equipment Procedures Preliminary planning Evaluating alternatives Discontinuing and Follow-Up Posttreatment assessment High-Flow Nasal Cannula Physiologic Basis Other Therapies Positive Airway Pressure (PAP) Physiologic Basis Indications Contraindications Hazards and Complications Equipment Procedures Monitoring and Troubleshooting Administration Preliminary planning Evaluating alternatives Discontinuing and Follow-Up Posttreatment assessment SELECTING AN APPROACH REFERENCES MULTIMEDIA RESOURCES Videos 44 - Airway Clearance Therapy PHYSIOLOGY OF AIRWAY CLEARANCE THERAPIES Normal Clearance Abnormal Clearance Diseases Associated With Abnormal Clearance GENERAL GOALS AND INDICATIONS Airway Clearance Therapy for Acute Conditions Airway Clearance Therapy for Chronic Conditions Airway Clearance Therapy to Prevent Retention of Secretions DETERMINING THE NEED FOR AIRWAY CLEARANCE THERAPY AIRWAY CLEARANCE METHODS Chest Physical Therapy (Also Known as Postural Drainage and Percussion) Technique Percussion and Vibration Manual percussion Mechanical percussion and vibration Coughing and Related Expulsion Techniques Directed Coughing Standard technique Modifications to directed coughing technique Forced Expiratory Technique Manual Assisted Coughing Active Cycle of Breathing Technique Autogenic Drainage Mechanical Insufflation-Exsufflation Positive Airway Pressure Adjuncts Positive Expiratory Pressure and Oscillating Positive Expiratory Pressure High-Frequency Positive Airway Pressure Devices High-Frequency Chest Wall Compression Exercise, Mobilization, and Physical Activity SELECTING AIRWAY CLEARANCE TECHNIQUES Selection Factors Outcome Assessment Documentation and Follow-Up Protocol-Based Airway Clearance REFERENCES MULTIMEDIA RESOURCES Additional Resources VI - Acute and Critical Care 45 - Respiratory Failure and the Need for Ventilatory Support HYPOXEMIC RESPIRATORY FAILURE (TYPE I) Ventilation/Perfusion Mismatch Clinical Presentation Right-to-Left Shunt Clinical Presentation Alveolar Hypoventilation Diffusion Impairment Clinical Presentation Perfusion/Diffusion Impairment Clinical Presentation Decreased Inspired Oxygen Clinical Presentation Venous Admixture Clinical Presentation Differentiating the Causes of Acute Hypoxemic Respiratory Failure HYPERCAPNIC RESPIRATORY FAILURE (TYPE II) Unexpected Exposure to Breathing Carbon Dioxide Clinical Presentation Increased Carbon Dioxide Production Clinical Presentation Impairment in Respiratory Control Clinical Presentation Impairment in Exhaling Carbon Dioxide Neurologic Diseases Clinical presentation Respiratory Diseases Clinical presentation Summary CHRONIC RESPIRATORY FAILURE (TYPE I AND TYPE II) Acute-on-Chronic Respiratory Failure Complications of Acute Respiratory Failure Clinical Presentation Indications for Ventilatory Support Parameters Indicating Need for Ventilatory Support Hypoxemic respiratory failure Hypercapnic respiratory failure (ventilatory failure) Significance of elevated alveolar partial pressure of carbon dioxide ASSESSMENT OF RESPIRATORY FATIGUE, WEAKNESS, FAILURE, AND WORK OF BREATHING Respiratory Muscle Weakness Respiratory Muscle Fatigue Respiratory Failure Work of Breathing CHOOSING A RESPIRATORY SUPPORT STRATEGY FOR DIFFERENT CAUSES OF RESPIRATORY FAILURE High-Flow Oxygen Therapy Noninvasive Ventilation Noninvasive Ventilation in Acute Conditions Exacerbations of Chronic Obstructive Pulmonary Disease Cardiogenic Pulmonary Edema Acute Asthma Acute Respiratory Distress Syndrome Noninvasive Ventilation in Chronic Conditions Obesity-Hypoventilation Syndrome Stable Chronic Obstructive Pulmonary Disease Neuromuscular Diseases and Thoracic Cage Abnormalities Invasive Ventilatory Support Acute Respiratory Distress Syndrome Increased Intracranial Pressure Obstructive Lung Disease Ventilatory Support in Acute-on-Chronic Hypercapnic Respiratory Failure REFERENCES 46 - Mechanical Ventilators HOW VENTILATORS WORK The Operator Interface Ventilator Displays Alphanumeric values Trends Waveforms and loops Picture Graphics Alarm Settings The Patient Interface IDENTIFYING MODES OF MECHANICAL VENTILATION The 10 Maxims for Understanding Modes Maxim 1: A Breath Is One Cycle of Positive Flow (Inspiration) and Negative Flow (Expiration) Defined in Terms of the Flow-T ... Maxim 2: A Breath Is Assisted If the Ventilator Provides Some or All of the Work of Breathing Maxim 3: A Ventilator Assists Breathing Using Either Pressure Control or Volume Control Based on the Equation of Motion for ... Maxim 4: Breaths Are Classified According to the Criteria That Trigger (Start) and Cycle (Stop) Inspiration Maxim 5: Trigger Variable and Cycle Events Can Be Initiated by Either the Patient or the Machine Maxim 6: Breaths Are Classified as Spontaneous or Mandatory Based on Both the Trigger and Cycle Events Maxim 7: There Are Three Basic Breath Sequences: Continuous Mandatory Ventilation, Intermittent Mandatory Ventilation, and ... Four types of IMV Maxim 8: There Are Five Basic Ventilatory Patterns: VC-CMV, VC-IMV, PC-CMV, PC-IMV, and PC-CSV Maxim 9: Ventilatory Patterns Vary According to Their Targeting Schemes (Set-Point, Dual, Bio-Variable, Servo, Adaptive, Op ... Descriptions of targeting schemes Maxim 10: A Mode of Ventilation Is Classified According to Its Control Variable, Breath Sequence, and Targeting Schemes A Taxonomy for Mechanical Ventilation How to Classify Modes Examples COMPARING MODES OF MECHANICAL VENTILATION TYPES OF VENTILATORS Conventional Versus High-Frequency Ventilators Conventional Ventilators High-Frequency Ventilators Classification of Ventilators by Use Critical Care Ventilators Subacute Care Ventilators Home Care Ventilators Transport Ventilators Noninvasive Ventilators REFERENCES 47 - Physiology of Ventilatory Support PRESSURE AND PRESSURE GRADIENTS Airway, Alveolar, and Intrathoracic Pressure, Volume, and Flow During Spontaneous Ventilation Airway, Alveolar, and Intrathoracic Pressure, Volume, and Flow During Negative-Pressure Mechanical Ventilation Airway, Alveolar, and Intrathoracic Pressure, Volume, and Flow During Positive-Pressure Mechanical Ventilation EFFECTS OF MECHANICAL VENTILATION ON VENTILATION Minute Ventilation Increased Alveolar Ventilation Ventilation/Perfusion Ratio Alveolar and Arterial Carbon Dioxide Acid-Base Balance EFFECTS OF MECHANICAL VENTILATION ON OXYGENATION Inspired Oxygen Alveolar Oxygen and Alveolar Air Equation Arterial Oxygenation and Oxygen Content Decreased Shunt Increased Tissue Oxygen Delivery EFFECTS OF POSITIVE PRESSURE MECHANICAL VENTILATION ON LUNG MECHANICS Time Constants Increased Pressure Mean Airway Pressure Effect of Peak Airway Pressure on Lung Recruitment Increased Lung Volume: Tidal Volume Increased Functional Residual Capacity Pressure-Volume Curve and Lung Recruitment in Acute Respiratory Distress Syndrome Increased Dead Space Decreased Work of Breathing MINIMIZING ADVERSE PULMONARY EFFECTS OF POSITIVE PRESSURE MECHANICAL VENTILATION Decreasing Pressure Positive End-Expiratory Pressure or Continuous Positive Airway Pressure Effects of Ventilatory Pattern Trigger Site and Work of Breathing PHYSIOLOGIC EFFECTS OF VENTILATORY MODES Volume-Controlled Ventilation Versus Pressure-Controlled Ventilation Continuous Mandatory Ventilation Volume-Controlled Continuous Mandatory Ventilation Pressure-Controlled Continuous Mandatory Ventilation Pressure-Controlled Inverse Ratio Ventilation Intermittent Mandatory Ventilation Volume-Controlled Intermittent Mandatory Ventilation Pressure-Controlled Intermittent Mandatory Ventilation Airway Pressure Release Ventilation Continuous Spontaneous Ventilation Continuous Positive Airway Pressure Pressure Support Ventilation Improved Modes Using Advanced Targeting Schemes Dual Targeting2 Servo Targeting2 Adaptive Targeting2 Bio-variable Optimal Targeting2 Intelligent Targeting2 bksec4_1 Ventilation Oxygenation Weaning Patient Positioning to Optimize Oxygenation and Ventilation Prone Positioning CARDIOVASCULAR EFFECTS OF POSITIVE PRESSURE MECHANICAL VENTILATION Thoracic Pump and Venous Return During Spontaneous and Mechanical Ventilation Compensation in Healthy Persons Pulmonary Vascular Pressure, Blood Flow, and Pulmonary Vascular Resistance Right and Left Ventricular Function Effect on Left Ventricular Dysfunction Endocardial Blood Flow Cardiac Output, Cardiac Index, and Systemic Blood Pressure MINIMIZING CARDIOVASCULAR EFFECTS OF POSITIVE PRESSURE MECHANICAL VENTILATION Mean Pleural Pressure Decreasing Mean Airway Pressure Fluid Management and Cardiac Output Pharmacologic Maintenance of Cardiac Output and Blood Pressure EFFECTS OF POSITIVE PRESSURE MECHANICAL VENTILATION ON OTHER BODY SYSTEMS (BOX 47.2) Increased Intracranial Pressure Treatment of a Patient With a Closed Head Injury Effect on Renal Function Decreased Liver and Splanchnic Perfusion Decreased Gastrointestinal Function Effect on Central Nervous System Sedatives, Hypnotics, and Neuromuscular Blocking Agents Opioids COMPLICATIONS OF MECHANICAL VENTILATION Negative Pressure Ventilation Pulmonary Cardiovascular Positive Pressure Ventilation: Artificial Airway Complications Complications Related to Pressure Complications Related to Volume Auto-Positive End-Expiratory Pressure Oxygen Toxicity Ventilator-Associated (Nosocomial) Pneumonia Prevention of Ventilator-Associated Pneumonia Ventilator Malfunction Operator Error REFERENCES 48 - Patient-Ventilator Interactions STEP 1: IDENTIFY THE GOAL OF MECHANICAL VENTILATION STEP 2: IDENTIFY THE MODE OF VENTILATION Control Variable Breath Sequence Types of IMV Targeting Scheme Mode TAG STEP 3: DETERMINE THE LOAD Volume Control-Square (Constant) Flow Waveform Effects of Resistance Effects of Compliance Effects of Pmus Volume Control-Descending Ramp (Decelerating) Flow Waveform Effects of Resistance Effects of Compliance Effects of Pmus Pressure Control Effects of Resistance Effects of Compliance Effects of Pmus Expiratory Mechanics STEP 4: DIAGNOSE THE PATIENT-VENTILATOR INTERACTION STATUS Trigger Inspiration Cycle Expiration Multiple Triggers STEP 5: SUMMARY AND INTERVENTION Evaluation and Quantification of PVI Discordances CONCLUSION REFERENCES MULTIMEDIA RESOURCES Additional Resources 49 - Initiating and Adjusting Invasive Ventilatory Support GOALS OF MECHANICAL VENTILATION Safely Provide Gas Exchange Lung-Protective Ventilatory Strategies Maximize Patient Comfort Promote Liberation VENTILATOR INITIATION Establishment of the Airway Pressure-Controlled Versus Volume-Controlled Ventilation Full Ventilatory Support Versus Partial Ventilatory Support Choice of a Ventilator INITIAL VENTILATOR SETTINGS Choice of Mode Continuous Mandatory Ventilation or Assist/Control Ventilation (Patient-Triggered or Time-Triggered Continuous Mandatory Ve ... Controlled Ventilation (Time-Triggered Continuous Mandatory Ventilation) Synchronized Intermittent Mandatory Ventilation Pressure Support Ventilation Airway Pressure Release Ventilation High PEEP or CPAP Low PEEP or CPAP High pressure time Low pressure time Concerns with APRV High-Frequency Oscillatory Ventilation Initial Choice of Mode Tidal Volume and Rate Trigger Sensitivity Inspiratory Flow, Inspiratory Time, and Inspiratory-to-Expiratory Ratio for Volume Ventilation Flow Waveform Inspiratory Pause Oxygen Percentage (Fractional Inspired Oxygen) Positive End-Expiratory Pressure and Continuous Positive Airway Pressure Open Lung Strategy, Recruitment Maneuvers, and Positive End-Expiratory Pressure Pressure Rise Time or Slope Limits and Alarms Humidification Periodic Sighs ADJUSTING VENTILATORY SUPPORT Patient-Ventilator Interaction OXYGENATION Oxygen Concentration Positive End-Expiratory Pressure and Continuous Positive Airway Pressure Minimum Positive End-Expiratory Pressure Optimal or Best Positive End-Expiratory Pressure Based on Oxygen Delivery Compliance-Titrated Positive End-Expiratory Pressure Positive End-Expiratory Pressure Titrated With Pressure-Volume Curves as Part of a Lung-Protective Strategy Positive End-Expiratory Pressure and Lung Recruitment Maneuvers Esophageal manometry Electrical impedance tomography Positive End-Expiratory Pressure Tables Other Techniques for Improving Oxygenation Bronchial Hygiene Prone Positioning VENTILATION Adjusting Tidal Volume and Rate Apnea (Controlled Ventilation) Rate Tidal volume Mechanical dead space Control of PaCO2 in Synchronized Intermittent Mandatory Ventilation Mode Assist/Control Mode Volume Ventilation and PaCO2 Pressure Support Ventilation and PaCO2 Pressure-Controlled Ventilation and PaCO2 PaCO2 When Using Lung-Protective Strategies for Acute Lung Injury and Acute Respiratory Distress Syndrome Open Lung Approach Other Lung Protective Strategies REFERENCES MULTIMEDIA RESOURCES Additional Resources 50 - Noninvasive Ventilation HISTORY AND DEVELOPMENT OF NONINVASIVE VENTILATION INDICATIONS FOR NONINVASIVE VENTILATION Goals and Benefits of Using Noninvasive Ventilation Acute Care Indications Acute Hypercapnic Respiratory Failure Chronic Obstructive Pulmonary Disease Asthma Facilitation of Weaning in Chronic Obstructive Pulmonary Disease Acute Hypoxemic Respiratory Failure Acute Cardiogenic Pulmonary Edema Community-Acquired Pneumonia Acute Respiratory Distress Syndrome Immunocompromised Patients Do-Not-Intubate and Comfort-Measures-Only Orders Postoperative Respiratory Failure Prevention of Reintubation in High-Risk Patients Postextubation Respiratory Failure Long-Term Care Indications Nocturnal Hypoventilation Restrictive Thoracic Diseases Amyotrophic Lateral Sclerosis Chronic Obstructive Pulmonary Disease With Stable Hypercapnia Obesity-Hypoventilation Syndrome SELECTING APPROPRIATE PATIENTS FOR NONINVASIVE VENTILATION Acute Care Setting Long-Term Care Setting Exclusion Criteria for Noninvasive Ventilation in a Long-Term Care Setting EQUIPMENT USED FOR NONINVASIVE VENTILATION Patient Interfaces Nasal and Oronasal Masks Nasal Pillows Hybrid Oronasal Mask Total Face Mask Helmet Choice of Patient Interface Types of Mechanical Ventilators and Modes of Ventilation Noninvasive Ventilators Critical Care Ventilators Intermediate Ventilators (Portable Home Care or Transport Ventilators) Heated Humidifiers MANAGEMENT OF NONINVASIVE VENTILATION Initial Application of Noninvasive Ventilation Clinical Assessment Criteria to Identify Success or Failure of Noninvasive Ventilation Adjusting Noninvasive Ventilator Settings Aerosolized Medication Delivery Safe Delivery of Noninvasive Ventilation Monitoring During Noninvasive Ventilation Patient Location Weaning From Noninvasive Ventilation COMPLICATIONS OF NONINVASIVE VENTILATION TIME AND COSTS ASSOCIATED WITH NONINVASIVE VENTILATION REFERENCES MULTIMEDIA RESOURCES Videos 51 - Extracorporeal Life Support THE RESPIRATORY THERAPIST AS AN EXTRACORPOREAL MEMBRANE OXYGENATION SPECIALIST PATIENTS RECEIVING EXTRACORPOREAL MEMBRANE OXYGENATION Newborns Pediatric and Adult Patients TYPES OF SUPPORT Venoarterial Extracorporeal Membrane Oxygenation Venovenous Extracorporeal Membrane Oxygenation Hybrid Configurations for Extracorporeal Membrane Oxygenation Extracorporeal Carbon Dioxide Removal PHYSIOLOGY EQUIPMENT CANNULAS INITIATION AND MAINTENANCE OF SUPPORT COMPLICATIONS ANTICOAGULATION MANAGEMENT TRANSPORTING A PATIENT ON EXTRACORPOREAL MEMBRANE OXYGENATION WEANING AND DECANNULATION REFERENCES MULTIMEDIA RESOURCES Additional Resources 52 - Monitoring the Patient in the Intensive Care Unit PRINCIPLES OF MONITORING History Pathophysiology and Monitoring MONITORING THE PATIENT-VENTILATOR SYSTEM Graphics Monitoring Monitoring During Lung-Protective Ventilation MONITORING OXYGENATION Arterial Pulse Oximetry Other Oxygenation Measures MONITORING VENTILATION Capnography MONITORING RESPIRATORY SYSTEM MECHANICS Direct Monitoring of Mechanics Equation of Motion Transrespiratory Pressure vs. Transpulmonary Pressure Resistance Compliance Respiratory system compliance Lung compliance Chest wall compliance Work and Power Indirect Monitoring of Mechanics Peak and Plateau Pressures Tidal (Driving) Pressure Mean Airway Pressure Auto-PEEP Methods for Determining Auto-PEEP End-expiratory hold by the ventilator Esophageal pressure measurements Using Positive End-Expiratory Pressure to Treat Auto-PEEP Stress Index Recruitment-to-Inflation Ratio Airway closure Obese patients Indirect Monitoring of Inspiratory Effort Work of Breathing Pressure-Time Product Occlusion Pressure IMAGING Ultrasound Lung Ultrasound Diaphragm Ultrasound Electrical Impedance Tomography HEMODYNAMICS Cardiac and Cardiovascular Monitoring Electrocardiography Monitoring Hemodynamic Pressures Monitoring of Arterial Blood Pressure Monitoring of Central Venous Pressure-Right Atrial Pressure Monitoring of Pulmonary Artery Pressure Preload Contractility Afterload Monitoring Cardiac Output NEUROLOGIC MONITORING Neurologic Status and Examination Pupillary Response Eye Movements Corneal Responses Gag Reflex Respiratory Rate and Pattern Motor Evaluation Sensory Evaluation Glasgow Coma Scale Intracranial Pressure Monitoring NUTRITIONAL MONITORING Assessment of Nutritional Status GLOBAL MONITORING INDICES TROUBLESHOOTING REFERENCES MULTIMEDIA RESOURCES Additional Resources 53 - Discontinuing Ventilatory Support REASONS FOR VENTILATOR DEPENDENCE Ventilatory Workload and Demand Ventilatory Capacity Global Criteria for Discontinuing Ventilatory Support PATIENT EVALUATION The Most Important Criterion Weaning Indices Ventilation Oxygenation Acid-Base Balance Metabolic Factors Renal Function and Electrolytes Cardiovascular Function Psychologic Factors and Central Nervous System Assessment Integrated Indices Evaluation of the Airway PREPARING THE PATIENT Optimizing the Patient\'s Medical Condition Patients\' Psychologic and Communication Needs CAREGIVER PREPARATION METHODS Rapid Ventilator Discontinuation Patients Who Need Progressive Weaning of Ventilatory Support Spontaneous Breathing Trials Continuous Positive Airway Pressure Synchronized Intermittent Mandatory Ventilation Pressure Support Ventilation Synchronized Intermittent Mandatory Ventilation With Pressure Support Ventilation Spontaneous Awakening Trials ABCDEF Bundle Role of Early Mobility NEWER TECHNIQUES FOR FACILITATING VENTILATOR DISCONTINUANCE Mandatory Minute Volume Ventilation Adaptive Support Ventilation/IntelliVent Computer-Based Weaning Automatic Tube Compensation Volume Support Proportional Assist Ventilation and Neurally Adjusted Ventilatory Assist Newer Techniques for Evaluation of Diaphragm Function and Prediction of Successful Discontinuation Noninvasive Ventilation/Continuous Positive Airway Pressure High-Flow Nasal Cannula Respiratory Therapist-Driven Protocols ATS/ACCP Ventilation Liberation Guidelines SELECTING AN APPROACH The Morbidly Obese Patient MONITORING THE PATIENT DURING WEANING Ventilatory Status Oxygenation Cardiovascular Status EXTUBATION Artificial Airways and Weaning Postextubation Complications VENTILATOR DISCONTINUANCE FAILURE PROLONGED MECHANICAL VENTILATION CHRONICALLY VENTILATOR-DEPENDENT PATIENTS TERMINAL/COMPASSIONATE EXTUBATION REFERENCES MULTIMEDIA RESOURCES Videos Additional Resources 54 - Neonatal and Pediatric Respiratory Care ASSESSMENT OF THE NEWBORN AND PEDIATRIC PATIENT Maternal Factors Fetal Assessment and Neonatal Transition Fetal Blood Gas Analysis During Labor Evaluation of the Newborn Apgar Score Assessment of Gestational Age Respiratory Assessment of the Infant Physical Assessment Manual Ventilation for Neonatal Resuscitation Pulmonary Surfactant Blood Gas and Pulse Oximetry Analysis Respiratory Assessment of the Pediatric Patient RESPIRATORY CARE Oxygen Therapy Goals and Indications Methods of Administration Surfactant Administration Airway Clearance Techniques Methods Monitoring Humidity and Aerosol Therapy Conditioning of Inspired Gases for Humidity Therapy Aerosol Drug Therapy Airway Management Intubation Suctioning Intubated Pediatric Patients CONTINUOUS POSITIVE AIRWAY PRESSURE Methods of Administration Heated, Humidified, High-Flow Nasal Cannula Noninvasive Ventilation MECHANICAL VENTILATION Basic Principles Indications and Goals of Mechanical Ventilation Ventilator Modes Provision of Positive Pressure Ventilation Ventilator Settings and Parameters Peak Inspiratory Pressure Positive End-Expiratory Pressure Tidal Volume (VT) Ventilator Rate Inspiratory Time Fraction of Inspired Oxygen Mean Airway Pressure Monitoring Mechanical Ventilation Physical Examination Patient-Ventilator Interaction Additional Monitoring Patient-Ventilator Periodic Assessment Changing Lung Mechanics in Childhood Liberation From Mechanical Ventilation High-Frequency Ventilation Cardiovascular Effects Weaning From High-Frequency Ventilation Complications of Mechanical Ventilation SPECIALTY GASES Inhaled Nitric Oxide Heliox NEONATAL AND PEDIATRIC TRANSPORT REFERENCES 55 - Health Promotion Through Patient Education HEALTH PROMOTION AND DISEASE PREVENTION POPULATION HEALTH AND CHRONIC DISEASE MANAGEMENT Implications for the Respiratory Therapist Healthcare Institutions Educational Institutions Community Work Site Home HEALTH EDUCATION PATIENT EDUCATION Cultural Awareness Health Literacy Establishing Goals for Patient Teaching Performance Objectives Learning Domains Cognitive Domain Psychomotor Domain Affective Domain Provide Educational Resources Teaching Children, Adolescents, Adults, and Older Adults Teaching Children and Their Parents Teaching Adolescents and Adults Teaching Older Adults Teach-Back or Echo Method Evaluation of Patient Education Patient Education Teaching Tips REFERENCES 56 - Cardiopulmonary Rehabilitation DEFINITIONS AND GOALS HISTORICAL PERSPECTIVE PHYSICAL AND PSYCHOSOCIAL BASIS Physical Reconditioning Psychosocial Support STRUCTURE OF A PULMONARY REHABILITATION PROGRAM Program Qualification Direct Patient Contact Requirement Removed Program Goals and Objectives Program Performance Measures Patient Evaluation and Selection Patient Evaluation The 6-Minute Walk Test Patient Selection Program Design Format Content Physical Reconditioning Educational Component Breathing control methods Methods of relaxation and stress management Secretion clearance and bronchial hygiene techniques Home oxygen and aerosol therapy Medications Dietary guidelines Recreational and vocational counseling Psychosocial and Behavioral Components Program Implementation Staffing Facilities Scheduling Class Size Equipment Web-Based Pulmonary Rehabilitation FINANCIAL CONSIDERATIONS Costs and Fees Reimbursement Qualifications Program Results Potential Hazards CARDIAC REHABILITATION CONCLUSION REFERENCES 57 - Respiratory Care in Alternative Settings MORE RECENT DEVELOPMENTS AND TRENDS RELEVANT TERMS AND GOALS Long-Term Subacute Care Hospitals Subacute Care Home Care STANDARDS Regulations Private Sector Accreditation TRADITIONAL ACUTE CARE VERSUS ALTERNATIVE SETTING CARE DISCHARGE PLANNING Multidisciplinary Team OXYGEN THERAPY IN ALTERNATIVE SETTINGS Oxygen Therapy Prescription Oxygen Qualification Criteria Supply Methods Compressed Oxygen Cylinders Liquid Oxygen Systems Oxygen Concentrators Problem Solving and Troubleshooting Delivery Methods Transtracheal Oxygen Therapy Demand-Flow Oxygen Systems Selecting a Long-Term Oxygen Delivery System Problem Solving and Troubleshooting VENTILATORY SUPPORT IN ALTERNATIVE SETTINGS Patient Selection Settings and Approaches Special Challenges in Providing Home Ventilatory Support Prerequisites Planning Caregiver Training Invasive Versus Noninvasive Ventilatory Support Equipment Selecting the Appropriate Ventilator Positive-Pressure Ventilators OTHER MODES OF RESPIRATORY CARE IN ALTERNATIVE SITES Bland Aerosol Therapy Aerosol Drug Administration Airway Care and Clearance Methods Continuous Positive Airway Pressure Therapy Equipment Determining Proper Continuous Positive Airway Pressure Level Sleep Remote Telemonitoring Use and Maintenance Problem Solving and Troubleshooting Apnea Monitoring PATIENT ASSESSMENT AND DOCUMENTATION Institutional Long-Term Care Screening Treatment Planning and Ongoing Assessment Discharge Summary Home Care Plan EQUIPMENT DISINFECTION AND MAINTENANCE REFERENCES 58 - Ethics and the End of Life ``GOALS OF CARE\'\' AS AN ESSENTIAL ORGANIZING FRAMEWORK Medical Prognosis and Rehabilitative Prognosis Values, Beliefs, and Preferences Particulars Context Relationships Ethical and Legal Parameters Refusal of Life-Sustaining Treatment Summary MANAGEMENT OF PAIN AND OTHER SYMPTOMS AT THE END OF LIFE: LEGAL AND ETHICAL CONSIDERATIONS Physician-Assisted Suicide Euthanasia Ethically Defensible Comfort-Oriented Care Rule of Double Effect Pain and Symptoms at the End of Life: Clarifying the Roles of the Physician and Healthcare Agent Palliative Sedation Withdrawal of Life-Sustaining Treatment Special Situations Patient Receiving Paralytics ETHICAL CONFLICT AT THE END OF LIFE Professional Position Statements, Empirical Data, and Hospital Policy Provide Support in Ethical Conflict THE RESPIRATORY THERAPIST AS ETHICAL PRACTITIONER REFERENCES GLOSSARY INDEX A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
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