Clinical application of mechanical ventilation / by Chang, David W.

Table of Contents: “…Pharmacotherapy For Mechanical Ventilation: -- Introduction -- Drugs for improving ventilation: -- Autonomic nervous system agents -- Adrenergic bronchodilators (Sympathomimetics) -- Anticholinergic bronchodilators (Parasympatholytics) -- Xanthine bronchodilators -- Anti-inflammatory agents (Corticosteroids) -- Delivery of MDI medications -- Neuromuscular blocking agents: -- Mechanism of action -- Characteristics of neuromuscular blocking agents -- Factors affecting neuromuscular blockade -- Factors affecting neuromuscular blockade -- Adverse effects -- Evaluation of neuromuscular blockade -- Central nervous system agents: -- Sedatives and antianxiety agents (Benzodiazepines) -- Opioid analgesics -- Agents for seizures and elevated intracranial pressure (Barbiturates) -- Other agents used in mechanical ventilation: -- Propofol -- Haloperidol -- Dexmedetomidine -- Nitric oxide -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Procedures Related To Mechanical Ventilation: -- Introduction -- Chest tube and drainage system: -- Indications for chest tube -- Chest tube selection and placement -- Methods of placement -- Chest tube drainage system -- Care and removal of chest tube -- Transport with chest tube -- Assisting in fiberoptic bronchoscopy: -- Indications for fiberoptic bronchoscopy -- Bronchoscope and medications -- Insertion of bronchoscope -- Types of specimen -- Complications -- Post bronchoscopy care -- Transport of mechanically ventilated patients: -- Indications -- Contraindications -- Equipment and supplies -- Types of transport -- Procedures for inter hospital transport -- Hazards and complications -- Magnetic resonance imaging -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Critical Care Issues In Mechanical Ventilation: -- Introduction -- Acute lung injury and acute respiratory distress syndrome -- Definitions of ALI and ARDS -- Pathophysiology -- Clinical presentations -- Lung protection using airway pressure thresholds -- Low tidal volume and permissive hypercapnia -- Decremental recruitment maneuver to determine optimal PEEP -- Prone positioning -- Ventilator-Associated Pneumonia (VAP): -- Incidence of VAP -- Clinical presentations -- Prevention of VAP -- Treatment of VAP -- Hypoxic-Ischemic Encephalopathy (HIE): -- General principles of HIE -- Cerebral perfusion pressure -- Decrease in CPP due to cardiac arrest -- Decrease in CPP due to shock -- Decrease in CPP due to brain injury -- Evaluation and treatment of HIE -- Trauma brain injury: -- Delayed brain injury -- Acceleration and deceleration brain injuries -- Clinical evaluation and assessment -- Management strategies -- Respiratory management -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Weaning From Mechanical Ventilation: -- Introduction -- Definition of weaning success and failure: -- Weaning success -- Weaning in progress -- Weaning failure -- Patient condition prior to weaning -- Weaning criteria: -- Ventilatory criteria -- Oxygenation criteria -- Pulmonary reserve -- Pulmonary measurements -- Rapid Shallow Breathing Index (RSBI) -- Weaning procedure: -- Spontaneous breathing trial -- Failure of SBT -- Pressure support ventilation -- Other modes of partial ventilatory support -- Weaning protocol -- Signs of weaning failure -- Causes of weaning failure: -- Increase of airflow resistance -- Decrease of compliance -- Respiratory muscle fatigue -- Terminal weaning: -- Prior to withdrawal -- Withdrawal -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Neonatal Mechanical Ventilation: -- Introduction -- Intubation: -- Indications -- Equipment -- Surfactant replacement therapy: -- History -- Indications -- Types of surfactant and dosages -- Outcomes -- Nasal CPAP: -- Use of nasal CPAP -- Basic principles of neonatal ventilation: -- Pressure-control ventilation -- Volume-controlled ventilation -- Ventilator circuits and humidifiers -- Initiation of neonatal ventilatory support: -- Indications for mechanical ventilation -- Initial ventilator settings -- High Frequency Ventilation (HFV): -- High Frequency Positive Pressure Ventilation (HFPPV) -- High Frequency Jet Ventilation (HFJV) -- High Frequency Oscillatory Ventilation (HFOV) -- Initial HFOV settings -- Other methods of ventilation: -- Machine volume -- Volume Guarantee -- Liquid ventilation -- Extracorporeal Membrane Oxygenation (ECMO): -- History -- Patient selection -- ECMO criteria -- Mechanisms of bypass -- Complications -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Mechanical Ventilation In Nontraditional Settings: -- Introduction -- Mechanical ventilation at home: -- Goals of Home Mechanical Ventilation (HMV) -- Indications and contraindications -- Patient selection -- Equipment selection -- Mechanical ventilation in mass casualty incidents: -- Causes of mass casualty -- Mass casualty and mechanical ventilation -- Triage systems for mass casualty incidents -- Strategic national stockpile -- Exclusion criteria for mechanical ventilation -- Personnel and planning -- Mechanical ventilation in hyperbaric condition: -- Rationale for Hyperbaric Oxygenation (HBO) -- Indications for HBO -- Endotracheal tube and ventilator -- Tidal volume fluctuations -- Monitoring and mechanical ventilation -- Defibrillation and cardiac pacing -- Mechanical ventilation in hypobaric condition: -- High-altitude cerebral and pulmonary edema -- Airplane cabin pressure -- Ventilator parameter changes under hypobaric conditions -- Pressure compensation -- Traveling with portable ventilators: -- Characteristics of portable ventilators -- Traveling in the United States -- Adjustment of tidal volume -- Portable oxygen concentrator -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Case Studies: -- Case 1: COPD -- Case 2: Status asthmaticus -- Case 3: Post-abdominal surgery -- Case 4: Head injury -- Case 5: Smoke inhalation -- Case 6: Drug overdose -- Case 7: Tension hemopneumothorax -- Case 8: Chest trauma -- Case 9: Acute respiratory distress syndrome -- Case 10: Myasthenia gravis -- Case 11: Guillain-Barre -- Case 12: Botulism -- Case 13: Meconium aspiration/patent ductus arteriosus -- Case 14: Persistent pulmonary hypertension of the newborn -- Case 15: Home care and disease management -- Case 16: End-of-life sedation on mechanical ventilation -- Appendix 1: Respiratory Care Calculations: -- A: Arterial oxygen tension to inspired oxygen concentration (PaO2/F1O2) index -- B: Cardiac Output (CO): Fick's estimated method -- C: Cerebral perfusion pressure -- D: Compliance: Dynamic (Cdyn) -- E: Compliance: Static (Cst) -- F: Corrected tidal volume (Vt) -- G: Deadspace to tidal volume Ratio (Vd/Vt) -- H: I:E Ratio -- I: Mean airway pressure (MPaw) -- J: Minute ventilation: expired and alveolar -- K: Oxygen content: arterial (CaO2) -- L: Oxygen index (OI) -- M: Shunt equation (Qsp/Qt): classic physiologic -- N: Shunt equation (Qsp/Qt): estimated -- O: Vascular resistance: pulmonary -- P: Vascular resistance: Systemic -- Q: Ventilator rate needed for a desired PaCO2 -- R: Weaning index: rapid shallow breathing -- Appendix 2: Normal Electrolyte Concentrations in Plasma -- Appendix 3: Oxygen transport normal ranges -- Appendix 4: Hemodynamic normal ranges -- Appendix 5: Glasgow coma score -- Appendix 6: Apache II severity of disease classification system -- Glossary -- Index.…”
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