Pilbeam's Mechanical Ventilation. Physiological and Clinical Applications

Front Cover
IFC
Title Page
Pilbeam\'s Mechanical Ventilation, 8th edition
Copyright
Dedication
Contributors
Preface
	ORGANIZATION
	FEATURES
	LEARNING AIDS
		Workbook
	FOR EDUCATORS
Acknowledgments
Contents
1 - Basic Terms and Concepts of Mechanical Ventilation
	PHYSIOLOGICAL TERMS AND CONCEPTS RELATED TO MECHANICAL VENTILATION
	NORMAL MECHANICS OF SPONTANEOUS VENTILATION
		Ventilation and Respiration
		Gas Flow and Pressure Gradients During Ventilation
		Units of Pressure
		Definitions of Pressures and Gradients in the Lungs
			Transairway Pressure
			Transthoracic Pressure
			Transpulmonary Pressure
			Transrespiratory Pressure
	LUNG CHARACTERISTICS
		Compliance
		Resistance
			Measuring Airway Resistance
	TIME CONSTANTS
	TYPES OF VENTILATORS AND TERMS USED IN MECHANICAL VENTILATION
	TYPES OF MECHANICAL VENTILATION
		Negative Pressure Ventilation
		Positive Pressure Ventilation
		High-Frequency Ventilation
	DEFINITION OF PRESSURES IN POSITIVE PRESSURE VENTILATION
		Baseline Pressure
		Peak Pressure
		Plateau Pressure
		Pressure at the End of Exhalation
	SUMMARY
	References
2 - How Ventilators Work
	HISTORICAL PERSPECTIVE ON VENTILATOR CLASSIFICATION
	INTERNAL FUNCTION
	POWER SOURCE OR INPUT POWER
		Electrically Powered Ventilators
		Pneumatically Powered Ventilators
		Positive and Negative Pressure Ventilators
	CONTROL SYSTEMS AND CIRCUITS
		Open-Loop and Closed-Loop Systems to Control Ventilator Function
		Control Panel (User Interface)
		Pneumatic Circuit
			Internal Pneumatic Circuit
			External Pneumatic Circuit
	POWER TRANSMISSION AND CONVERSION SYSTEM
		Compressors (Blowers)
		Volume Displacement Designs
		Volume Flow-Control Valves
	SUMMARY
	References
3 - How a Breath Is Delivered
	BASIC MODEL OF VENTILATION IN THE LUNG DURING INSPIRATION
	FACTORS CONTROLLED AND MEASURED DURING INSPIRATION
		Pressure-Controlled Breathing
		Volume-Controlled Breathing
		Flow-Controlled Breathing
		Time-Controlled Breathing
	OVERVIEW OF INSPIRATORY WAVEFORM CONTROL
	PHASES OF A BREATH AND PHASE VARIABLES
		Beginning of Inspiration: The Trigger Variable
			Time Triggering
			Patient Triggering
		The Limit Variable During Inspiration
			Pressure Limiting
			Volume Limiting
			Flow Limiting
			Maximum Safety Pressure: Pressure Limiting Versus Pressure Cycling
		Termination of the Inspiratory Phase: The Cycling Mechanism (Cycle Variable)
			Volume-Cycled Ventilation
			Set Volume Versus Actual Delivered Volume
				Tubing Compressibility
				System Leaks
			Time-Cycled Ventilation
			Flow-Cycled Ventilation
			Pressure-Cycled Ventilation
			Inflation Hold (Inspiratory Pause)
		Expiratory Phase: The Baseline Variable
			Definition of Expiration
			Baseline Pressure
			Time-Limited Expiration
			Continuous Gas Flow During Expiration
			Expiratory Hold (End-Expiratory Pause)
			Expiratory Retard
			Continuous Positive Airway Pressure and Positive End-Expiratory Pressure
	TYPES OF BREATHS
	SUMMARY
	References
4 - Establishing the Need for Mechanical Ventilation
	ACUTE RESPIRATORY FAILURE
		Recognizing the Patient in Respiratory Distress
		Definition of Respiratory Failure
		Recognizing Hypoxemia and Hypercapnia
	PATIENT HISTORY AND DIAGNOSIS
		Central Nervous System Disorders
		Neuromuscular Disorders
		Increased Work of Breathing
	PHYSIOLOGICAL MEASUREMENTS IN ACUTE RESPIRATORY FAILURE
		Bedside Measurements of Ventilatory Mechanics
			Maximum Inspiratory Pressure
			Vital Capacity
			Peak Expiratory Flow and Forced Expiratory Volume in 1 Second
			Respiratory Rate and Minute Ventilation
		Failure of Ventilation and Increased Dead Space
		Failure of Oxygenation
	OVERVIEW OF CRITERIA FOR MECHANICAL VENTILATION
	POSSIBLE ALTERNATIVES TO INVASIVE VENTILATION
		Noninvasive Positive Pressure Ventilation
		Intubation Without Ventilation
		Ethical Considerations
	SUMMARY
	References
5 - Selecting the Ventilator and the Mode
	NONINVASIVE AND INVASIVE POSITIVE PRESSURE VENTILATION: SELECTING THE PATIENT INTERFACE
		Noninvasive Positive Pressure Ventilation
			Continuous Positive Airway Pressure
			Noninvasive Positive Pressure Ventilation
		Invasive Positive Pressure Ventilation
	FULL AND PARTIAL VENTILATORY SUPPORT
	BREATH DELIVERY AND MODES OF VENTILATION
		Type of Breath Delivery
			Mandatory Breaths
			Spontaneous Breaths
			Assisted Breaths
		Targeting Volume as the Control Variable
		Targeting Pressure as the Control Variable
		Timing of Breath Delivery
	MODES OF VENTILATION
		History of Intermittent Positive Pressure Breathing and Intermittent Positive Pressure Ventilation: Understanding the Termi ...
		Continuous Mandatory Ventilation
			Controlled Ventilation
			Assisted Ventilation
		Volume-Controlled Continuous Mandatory Ventilation
		Pressure-Controlled Continuous Mandatory Ventilation
		Intermittent Mandatory Ventilation
		Spontaneous Modes
			Spontaneous Breathing
			Continuous Positive Airway Pressure
			Pressure Support Ventilation
				Additional settings in pressure support ventilation
	BILEVEL POSITIVE AIRWAY PRESSURE
	ADDITIONAL MODES OF VENTILATION
		Pressure Augmentation
		Pressure-Regulated Volume Control
		Volume Support Ventilation
		Mandatory Minute Ventilation
		Adaptive Support Ventilation
		Airway Pressure Release Ventilation
		Proportional Assist Ventilation
		Neurally Adjusted Ventilatory Assist
	SUMMARY
	References
6 - Initial Ventilator Settings
	DETERMINING INITIAL VENTILATOR SETTINGS DURING VOLUME-CONTROLLED VENTILATION
	INITIAL SETTINGS DURING VOLUME-CONTROLLED VENTILATION
		Setting Minute Ventilation
		Tidal Volume and Rate
			Tubing Compliance
			Mechanical Dead Space Considerations
		Relationship of Tidal Volume, Flow, Total Cycle Time, and Inspiratory-to-Expiratory Ratio
			Calculating Total Cycle Time and Respiratory Rate
			Calculating Inspiratory-to-Expiratory Ratio
			Inspiratory Time, Tidal Volume, and Flow
			Flow, Tidal Volume, and Inspiratory Time
		Inspiratory Flow and Flow Patterns
			Rate of Gas Flow
			Flow Patterns
				Constant flow
				Descending ramp
				Ascending ramp
				Sine flow
				Comparison of descending ramp and constant flow
				Concerns about high peak inspiratory pressure and mean airway pressure
				Effects of changing flow pattern in time-cycled versus volume-cycled ventilators
	SETTING THE MINUTE VENTILATION: SPECIAL CONSIDERATIONS
	INSPIRATORY PAUSE DURING VOLUME VENTILATION
	DETERMINING INITIAL VENTILATOR SETTINGS DURING PRESSURE VENTILATION
	SETTING BASELINE PRESSURE: PHYSIOLOGICAL POSITIVE END-EXPIRATORY PRESSURE
		Determining Tidal Volume Delivery in Pressure Ventilation
		Initial Settings for Pressure Support Ventilation
		Initial Settings for Pressure Control Ventilation
		Initial Settings for Bilevel Positive Airway Pressure Ventilation
		Initial Settings for Pressure Ventilation Modes With Volume Targeting
		Initial Settings of Pressure-Regulated Volume Control
		Initial Settings of Volume Support
	SUMMARY
	References
7 - Final Considerations in Ventilator Setup
	SELECTION OF ADDITIONAL PARAMETERS AND FINAL VENTILATOR SETUP
		Selection of Fractional Concentration of Inspired Oxygen
	SENSITIVITY SETTING
		Humidification
			Heated Humidifiers
			Heat-Moisture Exchangers
	ALARMS
		Action During Ventilator Alarm Situations
	PERIODIC HYPERINFLATION OR SIGHING
	FINAL CONSIDERATIONS IN VENTILATOR EQUIPMENT SETUP
		Preparing the Patient
		Establishing an Interface
		Manual Ventilation
		Cardiovascular Stabilization
		Ventilator Needs
		Treating the Cause of Respiratory Failure
	SELECTING THE APPROPRIATE VENTILATOR
	EVALUATION OF VENTILATOR PERFORMANCE
		Initial Ventilator Settings for Specific Patient Situations
	CHRONIC OBSTRUCTIVE PULMONARY DISEASE
		Guidelines for Patients With Chronic Obstructive Pulmonary Disease
	ASTHMA
		Guidelines for Patients With Asthma
	NEUROMUSCULAR DISORDERS
		Guidelines for Patients With Neuromuscular Disorders
	CLOSED HEAD INJURY
		Guidelines for Patients With a Closed Head Injury
	ACUTE RESPIRATORY DISTRESS SYNDROME
		Guidelines for Patients With ARDS
	ACUTE CARDIOGENIC PULMONARY EDEMA AND CONGESTIVE HEART FAILURE
		Guidelines for Patients With Congestive Heart Failure
	SUMMARY
	References
8 - Initial Patient Assessment
	DOCUMENTATION OF THE PATIENT-VENTILATOR SYSTEM
	THE FIRST 30 MINUTES
		Mode
		Sensitivity
		Tidal Volume, Rate, and Minute Ventilation
		Correcting Tubing Compliance
		Alveolar Ventilation
			Dead Space
			Added Mechanical Dead Space
			Final Alveolar Ventilation
	MONITORING AIRWAY PRESSURES
		Peak Inspiratory Pressure
		Plateau Pressure
		Set Pressure
		Transairway Pressure: PIP Minus Pplat
		Mean Airway Pressure
		End-Expiratory Pressure
		Driving Pressure
		Pressure Limit
			Low-Pressure Alarm
		Checking the Circuit: Checking for Leaks
	VITAL SIGNS, BLOOD PRESSURE, AND PHYSICAL EXAMINATION OF THE CHEST
		Heart Rate
		Temperature
		Systemic Arterial Blood Pressure
		Central Venous Pressure
		Pulmonary Artery Pressure
		Physical Examination of the Chest
	MANAGEMENT OF ENDOTRACHEAL TUBE AND TRACHEOSTOMY TUBE CUFFS
		Cuff Pressure Measurement
		High Cuff Pressure
		Nonexistent or Low Cuff Pressure
		Cut in the Pilot Tube
		Tube and Mouth Care
	MONITORING COMPLIANCE AND AIRWAY RESISTANCE
		Static Compliance
		Dynamic Characteristic (Dynamic Compliance)
		Airway Resistance
		Bedside Measurement of Pressure-Volume Curves
	COMMENT SECTION OF THE VENTILATOR FLOW SHEET
	SUMMARY
	References
9 - Ventilator Graphics
	RELATIONSHIP OF FLOW, PRESSURE, VOLUME, AND TIME
	A CLOSER LOOK AT SCALARS, CURVES, AND LOOPS
		Scalars
		Comparison of Pressure-Controlled Ventilation and Volume-Controlled Ventilation
		Determining the Mode of Ventilation
		Components of the Pressure-Volume Loop
			Spontaneous Breaths and Pressure-Volume Loops
		Components of the Flow-Volume Loop
		Summary: Normal Scalars, Loops, and Curves
	USING GRAPHICS TO MONITOR PULMONARY MECHANICS
	ASSESSING PATIENT-VENTILATOR ASYNCHRONY
	ADVANCED APPLICATIONS
		Auto-PEEP and Air Trapping
		Titrating PEEP
		APRV Settings
		Integrated Ventilator and Esophageal Graphics
		Assessing Overdistention During Pressure-Controlled Ventilation
		Inspiratory Rise Time Control: Sloping or Ramping
		Flow Cycling During Pressure Support Ventilation
	SUMMARY
	Bibliography
10 - Assessment of Respiratory Function
	NONINVASIVE MEASUREMENTS OF BLOOD GASES
		Pulse Oximetry
			Physiological and Technical Concerns
				Low Perfusion States
				Dysfunctional Hemoglobins and Dyes
				Nail Polish
				Skin Pigmentation
				Ambient Light
			Clinical Applications
	CAPNOGRAPHY (CAPNOMETRY)
		Technical Considerations
			Chemical Methods
			Infrared Spectroscopy
		Physiological Considerations
		Clinical Applications
			Capnograph Contours
			Arterial to Maximum End-Expiratory PCO2 Difference
		Volumetric Capnometry
			Description of the Single-Breath CO2 Curve
			Single-Breath CO2 Loop of Inspiration and Exhalation
			Trending CO2 Production and Alveolar Minute Ventilation Over Time
	EXHALED NITRIC OXIDE MONITORING
	TRANSCUTANEOUS MONITORING
		Transcutaneous PO2
		Transcutaneous PCO2
		Technical Considerations
	INDIRECT CALORIMETRY AND METABOLIC MEASUREMENTS
		Overview of Indirect Calorimetry
			Technical Considerations
				Obtaining Indirect Calorimetry Measurements
				Clinical Applications of Metabolic Measurements
	ASSESSMENT OF RESPIRATORY SYSTEM MECHANICS
	MEASUREMENTS
		Airway Pressure Measurements
		Flow Measurements
		Clinical Applications
			Measured Variables
			Derived Variables
				Mean airway pressure
				Dynamic and static compliances
			Airway resistance
			Work of breathing
			Work of breathing defined
			Graphic representation of WOB
			Pressure-time product
			Occlusion pressure measurements
	SUMMARY
	References
11 - Hemodynamic Monitoring
	REVIEW OF CARDIOVASCULAR PRINCIPLES
		Factors Influencing Cardiac Output
	OBTAINING HEMODYNAMIC MEASUREMENTS
		Hemodynamic Monitoring Systems
			Fluid Pressures
		Systemic Artery Catheterization
		Central Venous Lines
		Pulmonary Artery Catheterization
	INTERPRETATION OF HEMODYNAMIC PROFILES
		Heart Rate
		Systemic Arterial Pressure
		Right Atrial and Pulmonary Artery Pressures
			Atrial Pressures
			Pulmonary Artery Pressure
		Cardiac Output
			Fick Principle and Cardiac Output Measurements
			Indirect Fick Method
		Mixed Venous Oxygen Saturation
		Oxygen Delivery
		Shunt Fraction
		Vascular Resistance
		Ejection Fraction
		Cardiac Work
	CLINICAL APPLICATIONS
	SUMMARY
	References
12 - Methods to Improve Ventilation in Patient-Ventilator Management
	CORRECTING VENTILATION ABNORMALITIES
	COMMON METHODS OF CHANGING VENTILATION BASED ON PACO2 AND PH
		Respiratory Acidosis: Volume and Pressure Ventilation Changes
		Respiratory Alkalosis: VC-CMV and PC-CMV Changes
		Metabolic Acidosis and Alkalosis
		Metabolic Acidosis
		Metabolic Alkalosis
		Mixed Acid-Base Disturbances
		Increased Physiological Dead Space
		Increased Metabolism and Increased Carbon Dioxide Production
		Intentional Iatrogenic Hyperventilation
		Permissive Hypercapnia
		Procedures for Managing Permissive Hypercapnia
		Contraindications of Permissive Hypercapnia
		Airway Clearance During Mechanical Ventilation
	SECRETION CLEARANCE FROM AN ARTIFICIAL AIRWAY
		Hazards and Complications of Suctioning
		Closed-Suction Catheters (Inline Suction Catheters)
		Aspiration of Subglottic Secretions
		Normal Saline Instillation
		Assessment After Suctioning
	ADMINISTERING AEROSOLS TO VENTILATED PATIENTS
	TYPES OF AEROSOL-GENERATING DEVICES
		Ventilator-Related Factors
		Patient-Related Factors
		Circuit-Related Factors
		Use of Pressurized Metered-Dose Inhaler During Mechanical Ventilation
		Use of Small-Volume Nebulizers During Mechanical Ventilation
		Technical Problems Associated With Continuous Nebulization Using an External Gas Source
		Nebulization Provided by the Ventilator
		Use of Nebulizers During Noninvasive Positive Pressure Ventilation
		Patient Response to Bronchodilator Therapy
	POSTURAL DRAINAGE AND CHEST PERCUSSION
	FLEXIBLE FIBEROPTIC BRONCHOSCOPY
	ADDITIONAL PATIENT MANAGEMENT TECHNIQUES AND THERAPIES IN VENTILATED PATIENTS
		Sputum and Upper Airway Infections
	FLUID BALANCE
	PSYCHOLOGICAL AND SLEEP STATUS
	PATIENT SAFETY AND COMFORT
		Patient Safety
		Patient Comfort
		Patient-Centered Mechanical Ventilation
	TRANSPORT OF MECHANICALLY VENTILATED PATIENTS WITHIN AN ACUTE CARE FACILITY
	SUMMARY
	References
13 - Improving Oxygenation and Management of Acute Respiratory Distress Syndrome
	BASICS OF OXYGENATION USING FIO2, PEEP STUDIES, AND PRESSURE-VOLUME CURVES FOR ESTABLISHING OPTIMAL PEEP
		Basics of Oxygen Delivery to the Tissues
			Evaluating PaO2, SpO2, and FIO2 in Ventilator Patients
			Adjusting FIO2
			Selection of FIO2 or Adjustment of Mean Airway Pressures
	INTRODUCTION TO POSITIVE END-EXPIRATORY PRESSURE AND CONTINUOUS POSITIVE AIRWAY PRESSURE
		Pathophysiology of Atelectasis
		Goals of PEEP and CPAP
		Terminology
		Technical Aspects of PEEP and CPAP Devices
		Application of CPAP and PEEP to the Patient\'s Airway
			Mask CPAP
			Nasal CPAP
			Endotracheal or Tracheostomy Tubes
			Flow and Threshold Resistors
		Circuitry for Spontaneous CPAP With Freestanding Systems and Mechanical Ventilators
	PEEP RANGES
		Minimum or Low PEEP
		Therapeutic PEEP
		Optimal PEEP
	INDICATIONS FOR PEEP AND CPAP
	INITIATING PEEP THERAPY
	SELECTING THE APPROPRIATE PEEP/CPAP LEVEL (OPTIMAL PEEP)
		Application of PEEP Above 5 cm H2O
		Optimal PEEP Study
			Performing an Optimal PEEP Study
			Patient Appearance
			Blood Pressure
			Breath Sounds
			Ventilator Parameters
			Static Compliance
			Arterial Po2, FIO2, and PaO2/FIO2
			Arterial PaCO2 and pH
			Alveolar-to-Arterial Oxygen Tension (P(A-a)O2)
			Arterial to End-Tidal CO2 Tension Gradient (P(a-et)CO2)
			Hemodynamic Data
			Arterial-to-Venous Oxygen Content Difference
			Mixed Venous Oxygen Tension or Saturation
			Cardiac Output
	USE OF PULMONARY VASCULAR PRESSURE MONITORING WITH PEEP
	CONTRAINDICATIONS AND PHYSIOLOGICAL EFFECTS OF PEEP
		Contraindications for PEEP
		Pulmonary Effects of PEEP
		Transmission of Airway Pressure to Pleural Space
		Uses of PEEP for Problems Other Than ARDS
			PEEP and Congestive Heart Failure
			Mask CPAP as a Treatment for Postoperative Atelectasis and Hypoxemia
			Sleep Apnea
			Cystic Fibrosis
			Airway Suctioning With PEEP
	WEANING FROM PEEP
	ACUTE RESPIRATORY DISTRESS SYNDROME
	PATHOPHYSIOLOGY
	CHANGES IN COMPUTED TOMOGRAM WITH ARDS
	ARDS AS AN INFLAMMATORY PROCESS
		Two Categories of ARDS
		ARDS: A Heterogeneous Disorder-Normal Lung versus ARDS
	PEEP AND THE VERTICAL GRADIENT IN ARDS
	LUNG-PROTECTIVE STRATEGIES: SETTING TIDAL VOLUME AND PRESSURES IN ARDS
	LONG-TERM FOLLOW-UP ON ARDS
	PRESSURE-VOLUME LOOPS AND RECRUITMENT MANEUVERS IN SETTING PEEP IN ARDS
		Patient Evaluation for Lung Recruitment
		Pressure-Volume Loops in Setting PEEP
			Super-Syringe Technique
			Low-Flow (Quasi-Static) Technique
			Features of the SPV Loop
		Recruitment Maneuvers
			Illustration of a Recruitment Maneuver
			Function of Lung Recruitment
			Hazards of Recruitment Maneuvers
			Variability Among Patients
			Effects of Chest Wall Compliance on Lung Recruitment
			Potential Complications During Lung Recruitment
			Types of Recruitment Maneuvers
				Sustained inflation
				PC-CMV with a high PEEP level
				PC-CMV with increased PEEP
				Recruitment and decremental PEEP
				Sigh techniques
		Derecruitment Maneuver
	SUMMARY OF RECRUITMENT MANEUVERS IN ARDS
	IMPORTANCE OF BODY POSITION DURING POSITIVE PRESSURE VENTILATION
		Positioning in a Patient With ARDS: Prone Positioning
			Potential Mechanisms of Improved Oxygenation in Prone Positioning
			Technical Aspects of Prone Positioning
		Patient Position in Unilateral Lung Disease
	ADDITIONAL PATIENT CASES
	SUMMARY
	References
14 - Ventilator-Associated Pneumonia
	EPIDEMIOLOGY
		Causes and Risk Factors
	PATHOGENESIS OF VENTILATOR-ASSOCIATED PNEUMONIA
	DIAGNOSIS OF VENTILATOR-ASSOCIATED PNEUMONIA
		Clinical Diagnosis
		Bacteriological (Quantitative) Diagnosis
	TREATMENT OF VENTILATOR-ASSOCIATED PNEUMONIA
	STRATEGIES TO PREVENT VENTILATOR-ASSOCIATED PNEUMONIA
		Nonpharmacological Interventions
			Handwashing
			Semirecumbent Patient Positioning and Enteral Feeding
			Noninvasive Ventilation
			Selection, Changing, and Suctioning of the Endotracheal Tube
			Continuous Aspiration of Subglottic Secretions (CASS)
			Care of the Tracheostomy Tube
			Ventilator Circuit Management Strategies
			Kinetic Therapy
		Pharmacological Interventions
			Oropharyngeal Decontamination
			Stress Ulcer Prophylaxis
			Selective Digestive Tract Decontamination
			Prophylactic Antibiotics
			Sedation Interruption and Daily Assessment of Readiness for Endotracheal Extubation
	SUMMARY
	References
15 - Sedatives, Analgesics, and Paralytics
	SEDATIVES AND ANALGESICS
		Monitoring the Need for Sedation and Analgesia
		Benzodiazepines
			Diazepam
			Midazolam
			Lorazepam
			Dexmedetomidine
		Neuroleptics
		Anesthetic Agents
		Opioids
			Morphine
			Fentanyl
		Paralytics
		Monitoring Neuromuscular Blockade
		Depolarizing Agents
			Succinylcholine
		Nondepolarizing Agents
			Pancuronium
			Vecuronium
			Atracurium and Cisatracurium
	SUMMARY
	References
16 - Extrapulmonary Effects of Mechanical Ventilation
	EFFECTS OF POSITIVE PRESSURE VENTILATION ON THE HEART AND THORACIC VESSELS
	ADVERSE CARDIOVASCULAR EFFECTS OF POSITIVE PRESSURE VENTILATION
		The Thoracic Pump Mechanism During Normal Spontaneous Breathing and During Positive Pressure Ventilation
		Increased Pulmonary Vascular Resistance and Altered Right and Left Ventricular Function
		Coronary Blood Flow With Positive Pressure Ventilation
	FACTORS INFLUENCING CARDIOVASCULAR EFFECTS OF POSITIVE PRESSURE VENTILATION
		Compensation in Individuals With Normal Cardiovascular Function
		Effects of Lung and Chest Wall Compliance and Airway Resistance
		Duration and Magnitude of Positive Pressures
	BENEFICIAL EFFECTS OF POSITIVE PRESSURE VENTILATION ON HEART FUNCTION IN PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION
	MINIMIZING THE PHYSIOLOGICAL EFFECTS AND COMPLICATIONS OF MECHANICAL VENTILATION
		Mean Airway Pressure and PaO2
		Reduction in Airway Pressure
		Inspiratory Flow
		Inspiratory-to-Expiratory Ratio
		Inflation Hold
		Positive End-Expiratory Pressure
		High Peak Pressures From Increased Airway Resistance
		Intermittent Mandatory Ventilation
	EFFECTS OF MECHANICAL VENTILATION ON INTRACRANIAL PRESSURE, RENAL FUNCTION, LIVER FUNCTION, AND GASTROINTESTINAL FUNCTION
		Effects of Mechanical Ventilation on Intracranial Pressure and Cerebral Perfusion
	RENAL EFFECTS OF MECHANICAL VENTILATION
		Renal Response to Hemodynamic Changes
		Endocrine Effects of Positive Pressure Ventilation on Renal Function
		Arterial Blood Gases and Kidney Function
		Implications of Impaired Renal Effects
	EFFECTS OF MECHANICAL VENTILATION ON LIVER AND GASTROINTESTINAL FUNCTION
	NUTRITIONAL COMPLICATIONS DURING MECHANICAL VENTILATION
	SUMMARY
	References
17 - Effects of Positive Pressure Ventilation on the Pulmonary System
	LUNG INJURY WITH MECHANICAL VENTILATION
		Ventilator-Associated Lung Injury Versus Ventilator-Induced Lung Injury
		Barotrauma or Extraalveolar Air
			Subcutaneous Emphysema
			Pneumomediastinum
			Pneumothorax
			Pneumoperitoneum
		Barotrauma or Volutrauma
		Atelectrauma
			Shear Stress
			Surfactant Alteration
		Biotrauma
		Multiple Organ Dysfunction Syndrome
		Vascular Endothelial Injury
		Historic Webb and Tierney Study
		Role of PEEP in Lung Protection
		Ventilator-Induced Respiratory Muscle Weakness
	EFFECTS OF MECHANICAL VENTILATION ON GAS DISTRIBUTION AND PULMONARY BLOOD FLOW
		Ventilation to Nondependent Lung
		Ventilation-to-Lung Periphery
		Increase in Dead Space
		Redistribution of Pulmonary Blood Flow
		Effects of Positive Pressure on Pulmonary Vascular Resistance
	RESPIRATORY AND METABOLIC ACID-BASE STATUS IN MECHANICAL VENTILATION
		Hypoventilation
		Hyperventilation
		Metabolic Acid-Base Imbalances and Mechanical Ventilation
	AIR TRAPPING (AUTO-PEEP)
		How Auto-PEEP Occurs
		Physiological Factors That Lead to Auto-PEEP
		Identifying and Measuring Auto-PEEP
		Effect on Ventilator Function
		Measuring Static Compliance With Auto-PEEP
		Methods of Reducing Auto-PEEP
	HAZARDS OF OXYGEN THERAPY WITH MECHANICAL VENTILATION
		Oxygen Toxicity and the Lower Limits of Hypoxemia
		Absorption Atelectasis
		Depression of Ventilation
	INCREASED WORK OF BREATHING
		System-Imposed Work of Breathing
		Work of Breathing During Weaning
		Measuring Work of Breathing
		Steps to Reduce Work of Breathing During Mechanical Ventilation86,91
			Reducing Work Imposed by the Artificial Airway
			Setting Machine Sensitivity and Inspiratory Flow
			Patient-Ventilator Synchrony
				Trigger asynchrony
				Flow asynchrony
				Cycle asynchrony
				Mode asynchrony
				PEEP asynchrony
				Closed-loop ventilation asynchrony
			Reducing Minute Ventilation Demands
	VENTILATOR MECHANICAL AND OPERATIONAL HAZARDS
	COMPLICATIONS OF THE ARTIFICIAL AIRWAY
	SUMMARY
	References
18 - Troubleshooting and Problem Solving
	DEFINITION OF THE TERM PROBLEM
		Solving Ventilation Problems
	PROTECTING THE PATIENT
	IDENTIFYING THE PATIENT IN SUDDEN DISTRESS
	PATIENT-RELATED PROBLEMS
		Airway Problems
		Pneumothorax
		Bronchospasm
		Secretions
		Pulmonary Edema
		Dynamic Hyperinflation
		Abnormalities in Respiratory Drive
		Change in Body Position
		Drug-Induced Distress
		Abdominal Distention
		Pulmonary Embolism
	VENTILATOR-RELATED PROBLEMS
		Leaks
		Inadequate Oxygenation
		Inadequate Ventilatory Support
		Trigger Sensitivity
		Inadequate Flow Setting
		Other Examples of Patient-Ventilator Asynchrony
	COMMON ALARM SITUATIONS
		Low-Pressure Alarm
		High-Pressure Alarm
		Low-PEEP/CPAP Alarms
		Apnea Alarm
		Low-Source Gas Pressure or Power Input Alarm
		Ventilator Inoperative Alarm and Technical Error Message
		Operator Settings Incompatible With Machine Parameters
		Inspiratory-to-Expiratory Ratio Indicator and Alarm
		Other Alarms
	USE OF GRAPHICS TO IDENTIFY VENTILATOR PROBLEMS
		Leaks
		Inadequate Flow
		Inadequate Sensitivity Setting for Patient Triggering
		Overinflation
		Auto-PEEP
		Inadequate Inspiratory Time During Pressure Ventilation
		Waveform Ringing
		Expiratory Portion of Volume-Time Curve Below Baseline
		Patient-Ventilator Asynchrony
	UNEXPECTED VENTILATOR RESPONSES
		Unseated or Obstructed Expiratory Valve
		Excessive CPAP/PEEP
		Nebulizer Impairment of Patient\'s Ability to Trigger a Pressure-Supported Breath
		High Tidal Volume Delivery
		Altered Alarm Function
		Electromagnetic Interference
		Operator\'s Manuals
	SUMMARY
	References
19 - Basic Concepts of Noninvasive Positive Pressure Ventilation
	TYPES OF NONINVASIVE VENTILATION TECHNIQUES
		Negative Pressure Ventilation
		Positive Pressure Ventilation
	GOALS OF AND INDICATIONS FOR NONINVASIVE POSITIVE PRESSURE VENTILATION
		Acute Care Setting
			Acute Exacerbation of Chronic Obstructive Pulmonary Disease
			Asthma
			Hypoxemic Respiratory Failure
			Community-Acquired Pneumonia
			Cardiogenic Pulmonary Edema
		Chronic Care Setting
			Restrictive Thoracic Disorders
			Chronic Stable Chronic Obstructive Pulmonary Disease
			Cystic Fibrosis
			Nocturnal Hypoventilation
	OTHER INDICATIONS FOR NONINVASIVE VENTILATION
		Facilitation of Weaning From Invasive Ventilation
		“Do Not Intubate” Patients
	PATIENT SELECTION CRITERIA
		Acute Care Setting
		Chronic Care Setting
	EQUIPMENT SELECTION FOR NONINVASIVE VENTILATION
		Types of Ventilators
			Pressure-Targeted Ventilators
			Portable Homecare Ventilators
			Adult Acute Care Ventilators
		Humidification During Noninvasive Ventilation
		Patient Interfaces
		Nasal Interfaces
			Full (Oronasal) and Total Face Mask and Helmet
			Oral Interfaces
	SETUP AND PREPARATION FOR NONINVASIVE VENTILATION
	MONITORING AND ADJUSTMENT OF NONINVASIVE VENTILATION
	AEROSOL DELIVERY IN NONINVASIVE VENTILATION
	COMPLICATIONS OF NONINVASIVE VENTILATION
	DISCONTINUING NONINVASIVE VENTILATION
	PATIENT CARE TEAM CONCERNS
	SUMMARY
	References
20 - Weaning From and Discontinuation of Mechanical Ventilation
	WEANING TECHNIQUES
	METHODS OF TITRATING VENTILATOR SUPPORT DURING WEANING
		Intermittent Mandatory Ventilation
		Pressure Support Ventilation
		T-Piece Weaning
		Comparison of Traditional Weaning Methods
	CLOSED-LOOP CONTROL MODES FOR VENTILATOR DISCONTINUATION
		Automatic Tube Compensation
			Arguments Against the Use of Automatic Tube Compensation
			Summary of Automatic Tube Compensation
		Volume-Targeted Pressure Support Ventilation
		Automode and Variable Pressure Support/Variable Pressure Control
		Mandatory Minute Ventilation
		Adaptive Support Ventilation
		Artificial Intelligence Systems
	EVIDENCE-BASED WEANING
	EVALUATION OF CLINICAL CRITERIA FOR WEANING
		Recommendation 1: Pathology of Ventilator Dependence
		Weaning Criteria
		Patient Ventilatory Performance and Muscle Strength
		Measurement of Drive to Breathe
		Work of Breathing
		Adequacy of Oxygenation
		Recommendation 2: Assessment of Readiness for Weaning Using Evaluation Criteria
		Recommendation 3: Assessment During a Spontaneous Breathing Trial
		Recommendation 4: Removal of the Artificial Airway
		Postextubation Difficulties
		Noninvasive Positive Pressure Ventilation After Extubation
	FACTORS IN WEANING FAILURE
		Recommendation 5: Spontaneous Breathing Trial Failure
	NONRESPIRATORY FACTORS THAT MAY COMPLICATE WEANING
		Cardiac Factors
		Acid-Base Factors
		Metabolic Factors
		Effect of Pharmacological Agents
		Nutritional Status and Exercise
		Psychological Factors
		Recommendation 6: Maintaining Ventilation in Patients With Spontaneous Breathing Trial Failure
	FINAL RECOMMENDATIONS
		Recommendation 7: Anesthesia and Sedation Strategies and Protocols
		Recommendation 8: Weaning Protocols
		Recommendation 9: Role of Tracheostomy in Weaning
		Recommendation 10: Long-Term Care Facilities for Patients Requiring Prolonged Ventilation
		Recommendation 11: Clinician Familiarity With Long-Term Care Facilities
		Recommendation 12: Weaning in Long-Term Ventilation Units
	AMERICAN THORACIC SOCIETY/AMERICAN COLLEGE OF CHEST PHYSICIANS CLINICAL PRACTICE GUIDELINE: LIBERATION FROM MECHANICAL VENT ...
	ETHICAL DILEMMA: WITHHOLDING AND WITHDRAWING VENTILATORY SUPPORT
	SUMMARY
	References
21 - Long-Term Ventilation
	GOALS OF LONG-TERM MECHANICAL VENTILATION
	SITES FOR VENTILATOR-DEPENDENT PATIENTS
		Acute Care Sites
		Intermediate Care Sites
		Long-Term Care Sites
	PATIENT SELECTION
		Disease Process and Clinical Stability
		Psychosocial Factors
		Financial Considerations
	PREPARATION FOR DISCHARGE TO THE HOME
		Geographical and Home Assessment
		Family Education
		Additional Preparation
	FOLLOW-UP AND EVALUATION
		Adequate Nutrition
		Family Issues
	EQUIPMENT SELECTION FOR HOME VENTILATION
		Tracheostomy Tubes
		Ventilator Selection
			Examples of Homecare and Transport Ventilators
				First-generation portable volume ventilators
				Current-generation portable ventilators
	COMPLICATIONS OF LONG-TERM POSITIVE PRESSURE VENTILATION
	ALTERNATIVES TO INVASIVE MECHANICAL VENTILATION AT HOME
		Noninvasive Positive Pressure Ventilation
		Negative Pressure Ventilation
			Tank Ventilators/Iron Lungs
			The Chest Cuirass
			The Body Suit
		Additional Noninvasive Devices
		Diaphragm Pacing
		Continuous Positive Airway Pressure for Obstructive Sleep Apnea
			CPAP Systems
				Potential complications of CPAP
		Glossopharyngeal Breathing
	EXPIRATORY MUSCLE AIDS AND SECRETION CLEARANCE
		Assisted Coughing
		Mechanical Oscillation
		Mechanical Insufflation-Exsufflation
	TRACHEOSTOMY TUBES, SPEAKING VALVES, AND TRACHEAL BUTTONS
		Tracheostomy Tube Selection and Benefits
		Loss of Speech
		Speaking With Tracheostomy Tubes During Ventilation
			Electrically Activated Speaking Devices
		Speaking Tracheostomy Tubes
		Tracheostomy Speaking Valves
		Concerns With Speaking Tubes and Valves
		Tracheal Buttons and Decannulation
	ANCILLARY EQUIPMENT AND EQUIPMENT CLEANING FOR HOME MECHANICAL VENTILATION
		Disinfection Procedures
			Ventilator Circuit Disinfection
		Humidifiers
	SUMMARY
	References
22 - Neonatal and Pediatric Mechanical Ventilation
	RECOGNIZING THE NEED FOR MECHANICAL VENTILATORY SUPPORT
		Clinical Indications for Respiratory Failure
			Neonate
			Pediatric
		Determining Effective Oxygenation and Ventilation
	GOALS OF NEWBORN AND PEDIATRIC VENTILATORY SUPPORT
	NONINVASIVE RESPIRATORY SUPPORT
		Noninvasive Nasal Continuous Positive Airway Pressure in Neonates
			Indications and Contraindications
			Application of N-CPAP
			Complications of CPAP
		Noninvasive Positive Pressure Ventilation in Neonates
			Nasal Intermittent Mandatory Ventilation in Neonates
			Nasal “Sigh” Positive Airway Pressure in Neonates
			Noninvasive Nasal High-Frequency Ventilation in Neonates
		Continuous Positive Airway Pressure and Bilevel Positive Airway Pressure in Pediatric Patients
	CONVENTIONAL MECHANICAL VENTILATION
		Indications for Ventilatory Support of Neonates
		Indications for Ventilatory Support of Pediatric Patients
		The Pediatric Ventilator
		Pressure Control Mode
			Inspiratory Pressure
		Positive End-Expiratory Pressure
			Inspiratory Time, Expiratory Time, and Inspiratory-to-Expiratory Ratio
			Tidal Volume
			Frequency
			Mean Airway Pressure
			Inspired Oxygen Concentration
		Volume Control Mode
		Pressure Support Ventilation
		Dual-Control Mode
			Pressure-Regulated Volume Control
			Volume Guarantee
		Volume Support Ventilation
		Airway Pressure Release Ventilation
			Neurally Adjusted Ventilatory Assist
		Lung-Protective Strategies in Conventional Ventilation
	HIGH-FREQUENCY VENTILATION
		Indications for High-Frequency Ventilation
		Contraindications and Complications of High-Frequency Ventilation
		High-Frequency Ventilation Techniques
		High-Frequency Positive Pressure Ventilation
		High-Frequency Flow Interruption
		High-Frequency Percussive Ventilation
		High-Frequency Oscillatory Ventilation
		High-Frequency Jet Ventilation
		Physiology of High-Frequency Ventilation
		Management Strategies for High-Frequency Ventilation
			Management of High-Frequency Oscillatory Ventilation in Infants
	WEANING AND EXTUBATION
	ADJUNCTIVE FORMS OF RESPIRATORY SUPPORT
		Surfactant Replacement Therapy
		Prone Positioning
		Inhaled Nitric Oxide Therapy
	SUMMARY
	References
23 - Special Techniques Used in Ventilatory Support
	AIRWAY PRESSURE RELEASE VENTILATION
	OTHER NAMES
	ADVANTAGES OF AIRWAY PRESSURE RELEASE COMPARED WITH CONVENTIONAL VENTILATION
		Preserving Spontaneous Ventilation
		APRV and Airway Pressures During Spontaneous Breathing
	DISADVANTAGES
	INITIAL SETTINGS21,32,33
		Setting High Pressure
		Setting Low Pressure
		Setting High Time
		Setting Low Time
	ADJUSTING VENTILATION AND OXYGENATION21,32,33
	DISCONTINUATION
	HIGH-FREQUENCY OSCILLATORY VENTILATION IN THE ADULT
	TECHNICAL ASPECTS
	INITIAL CONTROL SETTINGS
		Mean Airway Pressure
		Amplitude
		Frequency
		Inspiratory Time Percentage
		Bias Flow
		Additional Settings
	INDICATION AND EXCLUSION CRITERIA
	MONITORING, ASSESSMENT, AND ADJUSTMENT
	ADJUSTING SETTINGS TO MAINTAIN ARTERIAL BLOOD GAS GOALS
	RETURNING TO CONVENTIONAL VENTILATION
	HELIOX THERAPY AND MECHANICAL VENTILATION
	GAS FLOW THROUGH THE AIRWAYS
	HELIOX IN AVOIDING INTUBATION AND DURING MECHANICAL VENTILATION
	POSTEXTUBATION STRIDOR
	DEVICES FOR DELIVERING HELIOX IN SPONTANEOUSLY BREATHING PATIENTS
		Mask Heliox
		Cost and Gas Consumption During Heliox Therapy
		Heliox and Aerosol Delivery
	MANUFACTURED HELIOX DELIVERY SYSTEM
	HELIOX AND AEROSOL DELIVERY DURING MECHANICAL VENTILATION
		Heliox With a Mechanical Ventilator
		Technical Considerations in Heliox Delivery
		Heliox and NIV
	MONITORING THE ELECTRICAL ACTIVITY OF THE DIAPHRAGM AND NEURALLY ADJUSTED VENTILATORY ASSIST
	REVIEW OF NEURAL CONTROL OF VENTILATION
	DIAPHRAGM ELECTRICAL ACTIVITY MONITORING
		History of Diaphragm Electrical Activity Monitoring
		The Edi Catheter: Its Characteristics and Placement
		Detecting Patient-Ventilator Asynchrony Using the Edi Catheter
		Using the Edi Waveform to Interpret Ventilator Synchrony
	NEURALLY ADJUSTED VENTILATORY ASSIST
		Using NAVA Ventilation
		Alarms and Safety Features in NAVA
		Results of Initiating NAVA Ventilation
		Weaning from NAVA
		Evaluating NAVA
	SUMMARY
	References
A - Answer Key
	PART 1: REVIEW QUESTIONS ANSWER KEY
		Chapter 1
			Basic Terms and Concepts of Mechanical Ventilation
		Chapter 2
			How Ventilators Work
		Chapter 3
			How a Breath Is Delivered
		Chapter 4
			Establishing the Need for Mechanical Ventilation
		Chapter 5
			Selecting the Ventilator and Mode
		Chapter 6
			Initial Ventilator Settings
		Chapter 7
			Final Considerations in Ventilator Setup
		Chapter 8
			Initial Patient Assessment
		Chapter 9
			Ventilator Graphics
		Chapter 10
			Assessment of Respiratory Function
		Chapter 11
			Hemodynamic Monitoring
		Chapter 12
			Methods to Improve Ventilation in Patient-Ventilator Management
		Chapter 13
			Improving Oxygenation and Management of Acute Respiratory Distress Syndrome
		Chapter 14
			Ventilator-Associated Pneumonia
		Chapter 15
			Sedatives, Analgesics, and Paralytics
		Chapter 16
			Extrapulmonary Effects of Mechanical Ventilation
		Chapter 17
			Effects of Positive Pressure Ventilation on the Pulmonary System
		Chapter 18
			Troubleshooting and Problem Solving
		Chapter 19
			Basic Concepts of Noninvasive Positive Pressure Ventilation
		Chapter 20
			Weaning and Discontinuation From Mechanical Ventilation
		Chapter 21
			Long-Term Ventilation
		Chapter 22
			Neonatal and Pediatric Mechanical Ventilation
		Chapter 23
			Special Techniques Used in Ventilatory Support
	PART 2: CASE STUDY ANSWER KEY
		Chapter 1: Basic Terms and Concepts of Mechanical Ventilation
			Case Study 1.1
				Determine Static Compliance (CS) and Airway Resistance (Raw)
		Chapter 2: How Ventilators Work
			Case Study 2.1
				Ventilator Selection
		Chapter 3: How a Breath Is Delivered
			Case Study 3.1
				Patient Triggering
			Case Study 3.2
				Premature Breath Cycling
		Chapter 4: Establishing the Need for Mechanical Ventilation
			Case Study 4.1
				Stroke Victim
			Case Study 4.2
				Unexplained Acute Respiratory Failure
			Case Study 4.3
				Ventilation in Neuromuscular Disorders
			Case Study 4.4
				Asthma Case
		Chapter 5: Selecting the Ventilator and Mode
			Case Study 5.1
				What type of breath is it?
			Case Study 5.2
				Pressure Control (PC-CMV) or Volume Control Ventilation (VC-CMV)
		Chapter 6: Initial Ventilator Settings
			Case Study 6.1
				Minute Ventilation (V˙E) Needs
			Case Study 6.2
				Minute Ventilation (V˙E), Tidal Volume (VT), and Respiratory Rate
			Case Study 6.3
				Inspiratory/Expiratory Ratio (I/E) and Flow
			Case Study 6.4
				Tidal Volume (VT) During Pressure Control Continuous Mandatory Ventilation (PC-CMV)
			Case Study 6.5
				Inspiratory Flow Termination in Pressure Support Ventilation (PSV)
			Case Study 6.6
				Pressure-Regulated Volume Control (PRVC)
		Chapter 7: Final Considerations in Ventilator Setup
			Case Study 7.1
				Auto-PEEP and Triggering
			Case Study 7.2
				Key Questions for ARDS Patient
			Case Study 7.3
				Troubleshooting: The Pulse Oximeter
		Chapter 8: Initial Patient Assessment
			Case Study 8.1
				The Importance of Documentation
			Case Study 8.2
				Circuit Disconnect
			Case Study 8.3
				Cuff Inflation Techniques
			Case Study 8.4
				Patient Assessment Cases
			Case Study 8.5
				Evaluating CS and Raw During Mechanical Ventilation
		Chapter 9: Ventilator Graphics
			Case Study 9.1
			Case Study 9.2
		Chapter 10: Assessment of Respiratory Function
			Case Study 10.1
				Causes of Cyanosis
			Case Study 10.2
				Capnography During Intubation
			Case Study 10.3
				Dead Space Ventilation
		Chapter 11: Hemodynamic Monitoring
			Case Study 11.1
				Evaluation of Pressure Tracing
			Case Study 11.2
				Cardiac Index and Stroke Index
			Case Study 11.3
				Application of the Fick Principle
			Case Study 11.4
				Stroke Work
			Case Study 11.5
				Hemodynamic Monitoring: After Open-Heart Surgery
			Case Study 11.6
				Hemodynamic Monitoring: Chest Injury
			Case Study 11.7
				ICU and Hemodynamic Assessment
		Chapter 12: Methods to Improve Ventilation in Patient-Ventilator Management
			Case Study 12.1
				Hyperventilation
			Case Study 12.2
				Assessment During Suctioning
			Case Study 12.3
				Evaluation of Bronchodilator Therapy
			Case Study 12.4
				Evaluating Fluid Status
		Chapter 13: Improving Oxygenation and Management of Acute Respiratory Distress Syndrome
			Case Study 13.1
				Myasthenia Gravis
			Case Study 13.2
				Changing FIO2
			Case Study 13.3
				Problem Solving: Infant CPAP
			Case Study 13.4
				Selecting Optimum PEEP
			Case Study 13.5
				Changing Patient Position
		Chapter 14: Ventilator-Associated Pneumonia
			Case Study 14.1
				Patient Case-VAP
			Case Study 14.2
				Patient Case-Methicillin-Resistant S. aureus
		Chapter 15: Sedatives, Analgesics, and Paralytics
			Case Study 15.1
				Patient Case-Discontinuing Lorazepam
			Case Study 15.2
				Patient Case-Agitated Patient
			Case Study 15.3
				Patient Case-Asynchrony
			Case Study 15.4
				Patient Case-Neuromuscular Blocking Agent
		Chapter 16: Extrapulmonary Effects of Mechanical Ventilation
			Case Study 16.1
				The Effects of Ventilator Changes on Blood Pressure
		Chapter 17: Effects of Positive Pressure Ventilation on the Pulmonary System
			Case Study 17.1
				Peak Pressure Alarm Activating
			Case Study 17.2
				Patient Case-Acute Pancreatitis
			Case Study 17.3
				Appropriate Ventilator Changes
			Case Study 17.4
				Difficulty Triggering in a Patient With COPD
		Chapter 18: Troubleshooting and Problem Solving
			Case Study 18.1
				Evaluating Severe Respiratory Distress in a Ventilated Patient
			Case Study 18.2
				Evaluating Peak Inspiratory Pressure (PIP) and Plateau Pressure (Pplat) in Volume-Controlled (VC) Ventilation
			Case Study 18.3
				Evaluating PIP and Volume in Pressure Control Ventilation
			Case Study 18.4
				Problem Solving Using Ventilator Graphics
			Case Study 18.5
				Evaluating a Ventilator Problem
		Chapter 19: Basic Concepts of Noninvasive Positive Pressure Ventilation
			Case Study 19.1
				Patient Selection for NIV
			Case Study 19.2
				Monitoring and Adjusting NIV
			Case Study 19.3
				Common Complications of NIV
		Chapter 20: Weaning and Discontinuation From Mechanical Ventilation
			Case Study 20.1
				Evaluation of Weaning Attempt
			Case Study 20.2
				Calculation of Rapid Shallow Breathing Index (RSBI)
			Case Study 20.3
				Failed Weaning Attempt
		Chapter 21: Long-Term Ventilation
			Case Study 21.1
				Patient Case-Difficulty Weaning
			Case Study 21.2
				Patient Case-Communication Difficulty
		Chapter 22: Neonatal and Pediatric Mechanical Ventilation
			Case Study 22.1
				Assessment and Treatment of a Newborn
			Case Study 22.2
				Adjustments to Home Therapy
			Case Study 22.3
				Patient Case-Acute Status Asthmaticus
			Case Study 22.4
				Recommending Changes in Ventilator Settings
			Case Study 22.5
				Evaluation of PRVC Dual-Control Mode
			Case Study 22.6
				Interpretation and Response to Monitored Data
			Case Study 22.7
				Patient Case-Acute Respiratory Distress Syndrome Managed With HFO
			Case Study 22.8
				Determining Appropriateness of Nitric Oxide Therapy
		Chapter 23: Special Techniques Used in Ventilatory Support
			Case Study 23.1
				Patient Assessment During HFOV
			Case Study 23.2
				Calculating Gas Flows During Heliox Therapy
	PART 3: CRITICAL CARE CONCEPTS ANSWER KEY
		Chapter 1: Basic Terms and Concepts of Mechanical Ventilation
			Critical Care Concept 1.1
				Calculate Pressure
		Chapter 2: How Ventilators Work
			Critical Care Concept 2.1
				Open Loop or Closed Loop
		Chapter 5: Selecting the Ventilator and the Mode
			Critical Care Concept 5.1
				Volume-Controlled Breaths With Changing Lung Characteristics
			Critical Care Concept 5.2
				Pressure-Controlled Breaths With Changing Lung Characteristics
		Chapter 6: Initial Ventilator Settings
			Critical Care Concept 6.1
				Tidal Volume (VT) and Ideal Body Weight (IBW)
			Critical Care Concept 6.2
				Inspiratory Flow in a Time-Cycled Ventilator
		Chapter 7: Final Considerations in Ventilator Setup
			Critical Care Concept 7.1
		Chapter 11: Hemodynamic Monitoring
			Critical Care Concept 11.1
				Fick Principle
		Chapter 16: Extrapulmonary Effects of Mechanical Ventilation
			Critical Care Concept 16.1
				Calculating Cardiac Transmural Pressure
B - Review of Abnormal Physiological Processes
	MISMATCHING OF PULMONARY PERFUSION AND VENTILATION
	PHYSIOLOGICAL DEAD SPACE AND ITS CLINICAL MONITORING
	CALCULATION OF MECHANICAL DEAD SPACE VOLUME NEEDED TO INCREASE PACO2
	SOME CAUSES OF HYPOXEMIA
		Shunt
			Calculation of Shunt
		Ventilation/Perfusion Abnormalities
		Diffusion Defects
	References
C - Graphics Exercises
	GRAPHING VENTILATOR WAVEFORMS
		Problem 1
	CHANGES IN WAVEFORMS WITH CHANGES IN LUNG CHARACTERISTICS
		Ventilator Working Pressure
			Constant-Flow Volume Ventilation With High Working Pressure
			Constant-Flow Volume Ventilation With Low Working Pressure
Glossary
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Index
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	B
	C
	D
	E
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	H
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