Mechanical Ventilation

Description

Mechanical Ventilation is a comprehensive guide to the evaluation and management of critically ill patients requiring mechanical ventilatory support. This new text helps respiratory care students and clinicians alike bridge the gap between theory and practice as they strive to provide the very best care for patients. Aimed at developing advanced practice and critical care respiratory therapists, the text covers key concepts, techniques, and procedures for providing safe and effective mechanical ventilation. Readers will learn to apply assessment skills to evaluate patients in impending or actual respiratory failure. After studying indications for mechanical ventilation, they will learn how to initiate mechanical ventilator support, adjust ventilation to keep patients stabilized, monitor patients over time, and discontinue ventilator support. A valuable resource to prepare for the National Board for Respiratory Care (NBRC) entry level and advanced respiratory care exams. Bridges the gap between theory and practice in the care of critically ill patients requiring mechanical ventilatory support. Focuses on interdisciplinary teams as they related to patient care and treatment Clinical Focus exercises serve as case studies to help readers refine their critical thinking and problem-solving skills Navigate 2 Advantage Access includes a full eBook, student practice activities and assessments, instructor resources and grading analytics tools. Robust set of Slides in PowerPoint format for each chapter, including an extremely comprehensive synopsis of ventilator types containing over 1000 slides! Title Page......Page 2 Copyright Page......Page 3 Dedication......Page 5 Brief Contents......Page 6 Contents......Page 7 Foreword......Page 24 Preface......Page 25 How to Use This Text......Page 27 Note from the Authors......Page 35 Acknowledgements......Page 37 Contributing Authors......Page 38 Reviewers......Page 41 Chapter 1 Introduction to Critical Respiratory Care......Page 43 Overview......Page 46 Critical Respiratory Care......Page 47 Types of Intensive Care Units......Page 50 Patients......Page 53 Personnel......Page 56 Intensive Care Unit Design......Page 61 Other Units......Page 64 Review of the Medical Record......Page 67 Patient History......Page 77 Physical Examination......Page 79 Laboratory Studies......Page 81 Imaging in the ICU......Page 83 Bronchoscopy and Thoracentesis......Page 84 Cardiac Monitoring in the ICU......Page 85 Types of Respiratory Care Provided in the ICU......Page 88 Summary......Page 91 Key Points......Page 92 References......Page 94 Chapter 2 Respiratory Failure......Page 95 Overview......Page 99 Respiratory Failure......Page 100 Types of Respiratory Failure......Page 101 Indications for Mechanical Ventilatory Support......Page 107 Clinical Manifestations of Respiratory Failure......Page 108 Oxygenation......Page 113 Assessment of Ventilation......Page 155 Alveolar Ventilation and Dead Space......Page 157 Alveolar Ventilation and PaCO2......Page 164 Assessment of Acid-Base Balance......Page 167 Assessment of Cardiac and Circulatory Status......Page 182 Assessment of Cognitive and Neurologic Status......Page 186 Nutritional Status......Page 193 Prediction of ICU Outcomes......Page 195 Acute Asthma Exacerbation......Page 197 Acute Exacerbation of COPD......Page 201 Acute Respiratory Distress Syndrome......Page 210 Heart Failure......Page 214 Acute Myocardial Infarction......Page 217 Shock......Page 218 Sepsis......Page 220 Trauma......Page 221 Pulmonary Embolus and Deep Vein Thrombosis......Page 224 Neurologic and Neuromuscular Disease......Page 226 Summary......Page 234 Key Points......Page 235 References......Page 240 Chapter 3 Principles of Mechanical Ventilation......Page 244 Introduction to Mechanical Ventilation......Page 248 Ventilation......Page 253 Spontaneous Breathing......Page 256 Negative Pressure Breathing......Page 259 Positive Pressure Breathing......Page 261 Invasive vs. Noninvasive Ventilation......Page 273 Input Power and Control Systems......Page 282 Ventilator Variables: Breath Trigger......Page 289 Ventilator Variables: Breath Cycle......Page 291 Operator Interface......Page 298 Ventilator Classification or Taxonomy......Page 300 Continuous Mandatory Ventilation......Page 306 Intermittent Mandatory Ventilation......Page 310 Positive End-Expiratory Pressure......Page 314 Continuous Positive Airway Pressure......Page 316 Pressure-Support Ventilation......Page 320 Airway Pressure-Release Ventilation......Page 321 Automatic Tube Compensation......Page 325 Proportional Assist Ventilation......Page 328 Dual Modes and Adaptive Control......Page 330 High-Frequency Ventilation......Page 335 Neurally Adjusted Ventilatory Assist......Page 339 Flow Waveforms......Page 345 Inspiratory Pause......Page 347 FIO2......Page 349 PEEP/CPAP......Page 350 Alarms......Page 351 Humidification......Page 354 Sigh Breaths......Page 355 Pulmonary System......Page 358 Cardiovascular System......Page 368 Renal System......Page 370 Gastrointestinal System......Page 371 Central Nervous System......Page 372 Pulmonary......Page 375 Extrapulmonary Organ Systems......Page 378 Key Points......Page 382 References......Page 386 Chapter 4 Mechanical Ventilators......Page 389 Introduction......Page 392 HAMILTON-G5......Page 394 HAMILTON-C3......Page 411 HAMILTON–C1......Page 426 Getinge Servo-i......Page 438 Getinge Servo-u......Page 453 Covidien Puritan Bennett 840 Ventilator......Page 467 Covidien Puritan Bennett 980 Ventilator......Page 479 Newport e360 Ventilator......Page 491 Vyaire AVEA......Page 503 Vyaire VELA......Page 519 Dräger Evita Infinity V500......Page 532 Dräger Evita XL......Page 546 GE Healthcare CARESCAPE R860......Page 558 Philips Respironics V60 Ventilator......Page 572 Vyaire 3100B High-Frequency Oscillator......Page 581 Percussionaire VDR-4......Page 585 Bunnell Life Pulse......Page 589 HAMILTON-T1......Page 594 HAMILTON–MR1......Page 606 Airon pNeuton......Page 620 pNeuton mini......Page 622 pNeuton Models A and S......Page 623 Bio-Med Devices Crossvent 4+......Page 625 Vyaire ReVel......Page 630 Vyaire LTV 1200......Page 643 Dräger Carina......Page 652 Dräger Oxylog 3000 Plus......Page 659 Medtronic Newport HT70 Plus......Page 669 ZOLL Eagle II......Page 678 Philips Respironics Trilogy Ventilator......Page 686 DeVilbiss IntelliPAP Bilevel S......Page 696 DeVilbiss IntelliPAP AutoBilevel......Page 699 ResMed Lumis Tx......Page 702 ResMed Astral 100/150......Page 709 Dräger Babylog VN500......Page 717 Smiths Medical Pneupac babyPAC 100......Page 728 Vyaire Infant Flow SiPAP......Page 733 Key Points......Page 739 References......Page 741 Chapter 5 Indications for Mechanical Ventilation......Page 743 Introduction......Page 746 Ventilation......Page 748 Ventilatory Capacity......Page 751 Ventilatory Requirements......Page 759 Assessment of Ventilation......Page 762 Clinical Manifestations of Respiratory Failure......Page 767 Goals of Mechanical Ventilatory Support......Page 771 Apnea......Page 772 Acute Ventilatory Failure......Page 775 Impending Ventilatory Failure......Page 780 Severe Oxygenation Problems......Page 784 Contraindications to Mechanical Ventilation......Page 790 Patient Assessment for Ventilator Initiation......Page 794 Initial Ventilator Settings......Page 798 Key Points......Page 803 References......Page 806 Chapter 6 Ventilator Initiation......Page 808 Introduction......Page 811 Goals of Mechanical Ventilation......Page 813 Negative-Pressure Ventilation......Page 815 Positive-Pressure Ventilation......Page 816 Endotracheal Intubation......Page 830 Tracheostomy......Page 836 Choice of a Ventilator......Page 840 Choice of Mode......Page 842 More on Nomenclature......Page 845 Full and Partial Ventilatory Support......Page 846 Major Modes of Ventilation......Page 849 Pressure Control-Continuous Spontaneous Ventilation......Page 868 Other Modes of Ventilation......Page 874 Mode......Page 893 Tidal Volume and Rate......Page 895 Inspiratory Phase, Expiratory Phase, and I:E Ratio......Page 900 Alarms and Limits......Page 914 Patient Assessment......Page 915 Acute Exacerbation of COPD......Page 916 Acute Respiratory Distress Syndrome......Page 917 Neuromuscular Disease......Page 918 Summary......Page 920 Key Points......Page 921 References......Page 925 Chapter 7 Patient Stabilization: Adjusting Ventilatory Support......Page 927 Introduction......Page 930 Initiation of Mechanical Ventilation......Page 931 Patient–Ventilator Interaction......Page 934 Trigger Asynchrony......Page 936 Flow Asynchrony......Page 941 Cycle Asynchrony......Page 943 Mode Asynchrony......Page 947 Oxygenation......Page 949 FIO2......Page 950 PEEP/CPAP......Page 955 Recruitment Maneuvers......Page 971 Prone Positioning......Page 972 Bronchial Hygiene......Page 973 Tidal Volume, Rate, and Minute Ventilation......Page 975 Alveolar Ventilation......Page 976 Alveolar Ventilation and Paco2......Page 977 PaCO2 during Mechanical Ventilation......Page 979 Acid-Base Balance......Page 989 Respiratory Alkalosis......Page 992 Metabolic Alkalosis......Page 993 Cardiac and Cardiovascular Support......Page 995 Use of Sedation and Neuromuscular Blockade......Page 999 Summary......Page 1000 Key Points......Page 1001 References......Page 1005 Chapter 8 Critical Care Patient Assessment and Monitoring: Part I: Assessment......Page 1006 Introduction......Page 1010 Medical Record Review......Page 1011 History......Page 1014 Patient and/or Family Interview......Page 1016 Physical Assessment......Page 1023 Assessment of Mental Status......Page 1042 Neurologic Examination......Page 1046 Pain Monitoring......Page 1047 Ancillary Use of Equipment......Page 1049 Chest Tubes, Drainage, and Management......Page 1050 Urine Output Monitoring......Page 1052 Bedside Assessment in the ICU......Page 1053 Arterial Sampling......Page 1055 Arterial Line Insertion and Sampling......Page 1059 Venous Blood Gases......Page 1062 Sample Analysis......Page 1063 Arterial Blood Gas Interpretation......Page 1064 Hemoglobin and Hematocrit......Page 1066 Complete Blood Count......Page 1067 Clinical Chemistry......Page 1070 Portable Chest Radiographs......Page 1077 Ultrasound Imaging......Page 1078 Bedside Tests of Spontaneous Breathing......Page 1079 Electrocardiogram......Page 1089 Key Points......Page 1105 References......Page 1109 Chapter 9 Critical Care Patient Assessment and Monitoring Part II: Monitoring and Care......Page 1111 Overview......Page 1115 Introduction......Page 1116 ICU Patient Assessment......Page 1117 Monitoring Ventilation......Page 1118 Respiratory Rate......Page 1120 Tidal Volume and Minute Ventilation Measurement and Evaluation......Page 1121 Alveolar Ventilation and Dead Space......Page 1128 I:E Ratio......Page 1130 Tests of Spontaneous Breathing......Page 1133 Airway Pressures......Page 1135 Compliance, Resistance, and Work of Breathing......Page 1140 Pressure, Flow, and Volume Curves......Page 1151 Optimal PEEP and Recruitment Maneuvers......Page 1171 Types of Recruitment Maneuvers......Page 1173 Pulse Oximetry......Page 1178 Capnometry, Capnography, and VD/VT......Page 1185 Transcutaneous O2/CO2......Page 1197 Exhaled Nitric Oxide......Page 1202 Electrocardiogram Monitoring......Page 1203 Hemodynamic Monitoring......Page 1204 Cardiopulmonary Calculations......Page 1215 Mechanical Circulatory Assistance......Page 1218 Pain Monitoring......Page 1220 Renal Function and Urine Output Monitoring......Page 1221 Temperature Monitoring and Regulation in the ICU......Page 1222 Nutritional Support......Page 1223 Managing and Monitoring the Patient Airway......Page 1225 Endotracheal Tube Characteristics......Page 1231 Cuff Pressure and Volume......Page 1235 Managing the Artificial Airway......Page 1236 Tracheostomy Tubes......Page 1247 Patient Care......Page 1252 Bronchial Hygiene and Airway Care......Page 1253 Patient–Ventilator System Monitoring......Page 1256 Recognition and Treatment of Common Complications......Page 1260 Key Points......Page 1280 References......Page 1285 Chapter 10 Noninvasive Ventilation......Page 1289 Introduction......Page 1291 Chronic Obstructive Pulmonary Disease......Page 1292 Asthma......Page 1293 Cardiogenic Pulmonary Edema......Page 1294 Preintubation......Page 1295 Acute Respiratory Distress Syndrome......Page 1296 Bronchoscopy......Page 1298 Sleep Apnea and Obesity Hypoventilation Syndrome......Page 1299 Trauma......Page 1300 Neuromuscular Disease......Page 1301 Interface......Page 1304 Types of Ventilators......Page 1307 Settings......Page 1310 Ongoing Management......Page 1313 Monitoring......Page 1315 Discontinuing NIV......Page 1316 Facial Pressure Ulcers......Page 1317 High-Flow Nasal Cannula......Page 1320 Specialty Modes of NIV Support......Page 1321 Key Points......Page 1322 References......Page 1323 Chapter 11 High-Frequency Oscillatory Ventilation for Acute Respiratory Distress Syndrome in Adults......Page 1327 Introduction......Page 1329 Oxygenation......Page 1332 Lung Recruitment Maneuvers during HFOV......Page 1338 Ventilation......Page 1339 Prone Positioning......Page 1342 Inhaled Nitric Oxide......Page 1343 Tracheostomy......Page 1344 Transition to Extracorporeal Membrane Oxygenation......Page 1345 Fluctuation of mPaw and ∆P......Page 1347 Transition from HFOV to Lung-Protective Conventional Ventilation......Page 1348 Transport of Patients on HFOV......Page 1349 Bronchoscopy During HFOV......Page 1350 Pneumothorax......Page 1353 Endotracheal Tube Misplacement or Obstruction......Page 1354 Infection Control......Page 1355 Key Points......Page 1357 References......Page 1358 Chapter 12 Diagnostic and Supportive Procedures in the ICU......Page 1364 Introduction......Page 1367 Diagnostic Bronchoscopy......Page 1368 Thoracentesis......Page 1373 Temperature Regulation in the ICU......Page 1377 Overview and Definitions......Page 1383 Nutrition in the ICU......Page 1386 Indications......Page 1393 Methods......Page 1394 Discontinuance......Page 1396 Indications......Page 1400 Methods......Page 1401 Monitoring......Page 1406 Discontinuance of Mechanical Circulatory Support......Page 1407 Key Points......Page 1409 References......Page 1411 Chapter 13 Point-of-care Ultrasound in Critical Care......Page 1413 The History and Evolution of Point-of-care Ultrasound......Page 1415 Types of Transducers......Page 1416 Holding and Moving the Transducer......Page 1417 General Concepts......Page 1419 Parasternal Long-axis View......Page 1420 Parasternal Short-axis View......Page 1422 Apical Four-chamber View......Page 1423 Subcostal View......Page 1426 Assessment of Volume Responsiveness......Page 1428 General Concepts......Page 1431 Detection of Pneumothorax......Page 1432 Evaluation of Pleural Effusion......Page 1433 Characteristics of Pleural Effusion......Page 1434 Pleural Drainage Procedures......Page 1435 Determining the Etiology of Respiratory Failure......Page 1436 Anatomic Landmarks......Page 1438 Assessment for Ascites and Paracentesis......Page 1439 Vascular Access......Page 1441 Detection of Deep Vein Thrombosis......Page 1442 Ultrasound-Guided Lumbar Puncture......Page 1443 Key Points......Page 1445 References......Page 1447 Chapter 14 Mechanical Ventilation During Extracorporeal Membrane Oxygenation......Page 1448 Introduction......Page 1450 Decision to Transition to ECMO......Page 1451 Approach to ECMO......Page 1452 Transitioning Off ECMO......Page 1459 Emergent Transition from ECMO to Mechanical Ventilation......Page 1462 Special Respiratory Care Issues During ECMO......Page 1463 Key Points......Page 1465 References......Page 1466 Chapter 15 Neonatal and Pediatric Critical Care......Page 1468 Introduction......Page 1471 Fetal Lung Development......Page 1472 Fetal Circulation......Page 1473 Transition to Extrauterine Life......Page 1476 Recognizing Respiratory Distress......Page 1477 Other Causes of Respiratory Distress......Page 1478 Assess the Gestational Age of the Patient......Page 1479 Respiratory Distress Syndrome......Page 1481 Persistent Pulmonary Hypertension of the Newborn......Page 1485 Meconium Aspiration Syndrome......Page 1486 Chronic Lung Disease......Page 1487 Other Conditions Seen in Premature Infants......Page 1488 Pediatric ARDS......Page 1491 Asthma......Page 1495 Neurologic Conditions......Page 1497 Neuromuscular Diseases......Page 1499 Bronchiolitis......Page 1500 Cystic Fibrosis......Page 1501 Monitored Parameters......Page 1504 Expected Values for Important Respiratory Parameters......Page 1506 Endotracheal Tube Selection and Management......Page 1507 Securing the Endotracheal Tube......Page 1508 Noninvasive Support......Page 1509 Conventional Mechanical Ventilation......Page 1511 Helium–Oxygen Mixtures......Page 1519 Nitric Oxide......Page 1520 Subambient Oxygen and Inhaled Carbon Dioxide......Page 1526 Anesthetic Gas Mixtures......Page 1528 Extracorporeal Membrane Oxygenation......Page 1532 Indications......Page 1537 Cardiac Applications......Page 1539 Complications......Page 1540 Patient Transport......Page 1541 Mechanical Ventilation during Transport......Page 1542 Safety Implications......Page 1543 Key Points......Page 1544 References......Page 1546 Chapter 16 Ventilator Discontinuance......Page 1554 Introduction......Page 1556 Ventilator Discontinuation......Page 1558 Factors That Contribute to Ventilator Dependence......Page 1560 Ventilatory Capacity Versus Ventilatory Requirements......Page 1562 Reversal or Improvement of Disease or Condition......Page 1566 Assessment of Ventilation and Acid-Base Balance......Page 1567 Assessment of Cardiovascular and Hemodynamic Status......Page 1572 Assessment of Medical Condition......Page 1575 Assessment of the Airway......Page 1581 Weaning Indices......Page 1587 Methods......Page 1594 IMV/SIMV......Page 1595 Pressure-Support Ventilation......Page 1596 Spontaneous Breathing Trials......Page 1597 Newer Methods......Page 1600 Selection and Approach......Page 1601 Monitoring......Page 1602 Monitoring Following Extubation......Page 1603 Management of Postextubation Upper Airway Obstruction......Page 1606 Extubation Failure......Page 1607 Long-Term Ventilator Dependence......Page 1610 Terminal Weaning......Page 1615 Key Points......Page 1616 References......Page 1619 Appendix A Patient Assessment and the National Board for Respiratory Care (NBRC) Examinations......Page 1621 Appendix B Abbreviations......Page 1634 Appendix C Equations......Page 1640 Glossary......Page 1643 Index......Page 1664