Practical Applications of Mechanical Ventilation Shaila Shodhan Kamat
INDEX
Page numbers followed by f refer to figure.
A
Abdominal distension 71
Abdominal muscles 21
Abdominal paradox 732
Abdominal pressure 71
ventilator 193
Abdominal surgery 736
Acid-base balance 704
ADH, effects of 498, 499f
Aerosolised epinephrine 730
Aerosols in-line circuit nebuliser 599
Air leaks 541f, 552, 553f
Air trapping and auto-PEEP 543, 543f, 551
Airflow
classification of 79
limitation 612
rate of 77
types of 82
Airway calibre 81
Airway closure 121, 124
Airway dead space 53
Airway disease 565
Airway inflammation 577
Airway obstruction after intensive therapy 595
Airway obstruction 249
Airway occlusion pressure 712
Airway opening pressure 148, 239
Airway pressure 275, 411, 445f
control of 396
controlled ventilation with PEEP 481f
degree of 269
gradient 189f
release ventilation 644, 447
ventilation 442
Airway protection 690
Airway reflex, protection of 705
Airway resistance 77, 81, 83, 85, 86, 87, 131, 284, 299, 322, 549f, 713
Airway, chronic obstructive 577
Airway, diameter of 82
Airway, generations of 6f
Airway, patency of 34
Alarm 295
classification of 295
for volume support 440
limits 454
output control 295, 297
Alveolar air equation 40
Alveolar and extra alveolar
effects of 495f
vessels 25, 25f
Alveolar capillary
block 111
interface 38
membrane 10, 41, 111
units 162
Alveolar carbon dioxide 42
tension 40, 42, 43, 562
Alveolar collapse expansion - atelectotrauma 516f, 635, 636f
Alveolar dead space 53, 55, 56f, 57, 97
Alveolar distending pressure 149, 149f, 240, 477, 477f
Alveolar fluid 97
Alveolar gas equation 287
Alveolar lining fluid 70
Alveolar membrane, diffusion across 15
Alveolar oedema 517
Alveolar oxygen tension 40
Alveolar pressure 22, 62, 77, 79, 149, 153, 162, 239, 245, 277, 477
transmission of 162f
Alveolar recruitment 485f
Alveolar rupture 531
Alveolar septal destruction 97
Alveolar surface tension 60, 61f
Alveolar ventilation 39, 39f, 40, 42, 44, 46, 50, 51, 286, 563, 563f
equation 42, 287
Alveolar vessels 173, 174, 495
Alveolar volume 38, 275, 286
Alveoli 10, 75
destruction of 111
fand slow 308
Anaesthetic management for ventilating patient 582
Anaesthetic significance of ascending paralysis 688
Analgesia
paralysis 685
sedation 685
Anatomic dead space 53, 54f
Ankylosis 72
Antibiotics 603
Anticholinergic drugs 10
Anti-mods monitoring 661
Anti-mods warning signs 664
Antioxidants 663
Apneusis 13
Apneustic breathing 13
Apneustic centre 13
Apnoea
alarm 303f
monitoring 303
period of 304
trigger of 304
Apparatus dead space 53, 57, 57f
ARDS 71
and cardiogenic pulmonary oedema, differentiate between 632
net-oxygenation goal 650
pathophysiology of 629f
treatment of 638
Arterial and systemic oxygenation 517f
Arterial blood gases 31f, 580, 637, 735
Arterial blood with plasma 223
Arterial blood, oxygen content in 219, 219f
Arterial carbon dioxide tension 562, 709
Arterial hypoxaemia 88, 88f
Arterial oxygen
content 219, 230
partial pressure 707
saturation 221, 514, 707
tension 487
Arterial oxyhaemoglobin saturation 510
Arterial pressure 680
Arterial venous oxygen content difference 511
Artificial ventilation 71f
using BIPAP 456
Aspiration 71
Assisted ventilation 367
Asthma 577, 578, 589
attack 520, 577
pathophysiology of 578f
pharmacological strategy in severe 596
ventilatory management of severe 577
Atelectasis 71, 97, 111, 126, 480
Atelectatic unit 90f
Atelectotrauma 158, 172, 636
prevention of 173, 515
Atmospheric pressure 77, 153, 324
Atrial natriuretic peptide 159, 500
effects of 176
on renal system 501f
Audible alarms 294
Auto-PEEP in lung 523f
B
Baby lung 73, 73f, 321, 321f, 648
Bacteriological screening 638
Balloon, low compliance of 309, 309f
Balloon, narrowed tube of 308
Bandages 72
Barometric pressure 110
Barotrauma 158, 170, 269, 377, 385, 472, 603
consequence of 170
factors influencing 268
signs of 170
symptoms of 170
Barotrauma/volutrauma, lesser chance of 411
Benzodiazepine 685, 695
with narcotics 585
Beta agonist, side effects of 605
Beta stimulation 10
Bicarbonate 597
BIPAP - APRV 447f, 643
BIPAP - genuine 448
BIPAP - IPPV 446, 446f
BIPAP - pressure support 449, 450f
BIPAP - SIMV 448, 448f
BIPAP technique 444, 444f
BIPAP ventilation 455
BIPAP with PSV 722
BIPAP, special features of 445
BIPAP/bi-level mode 482
Biphasic cuirass ventilation 193
Blood counts 595
Blood gas 693
abnormal 675
analysis 595
Blood low PaO2 708
Blood pressure 167, 493
Blood transfusions 660
Body surface pressure 148, 239
Bohr dead space equation 52
Bohr effect 226, 227
Bony development of cage 70
Boyle's law 103
Brain injury 673, 679
primary 674
secondary 674
Brain tissue oxygen tension 685
Brain trauma foundation 674
Brain-lung cross talk 678
Brainstem 11
Breath 406, 437, 526, 531, 547, 688
abnormal regulation of 689
basic model of 203
before weaning starts 717
circuit 199
components of 130f, 363f
control of 10, 338f, 367f, 369
cycle and inspiratory 271
decrease work of 427
dual control 437
during sleep 688
in auto-PEEP 526
mechanics of 17
normal regulation of 28, 28f
normal spontaneous 134, 206
pattern/ventilatory mechanics 706, 710
positive pressure 198f
rapid 732, 732f
test 469f
time alarms 304
to breath 437
types of 337, 338, 362, 369, 386, 406, 406f
support 418
with CPAP 481f
work of 127, 706, 716
Bronchi, angle of 6, 7f
Bronchial muscle tone 83
Bronchial tree 3, 5
subdivisions of 6f
Bronchoalveolar lavage 633
Bronchodilators improve ventilation 529f
Bronchopleural fistula 251, 413
Bronchopneumonia 71
Bronchopulmonary dysplasia 284
Bronchospasm 620
Bulk flow 48
C
Capillary hydrostatic pressure 162
Capillary shunt 90, 97
Carbon dioxide 26, 112f, 562
diffusion 112
elimination of 41, 215
in blood 513
partial pressure of 482
production of 41, 711
retention, risk of 412
tension 226
transportation of 41
Carbon monoxide 227
Cardiac arrhythmias 622
Cardiac atrial cell 500
Cardiac complications 604
Cardiac effect by PPV with PEEP 490f
Cardiac filling pressures 662
Cardiac output 489, 490f, 510, 566
reduction of 232
with PEEP 489
Cardiac performance 162
Cardiogenic pulmonary oedema 519
Cardiorespiratory function 514
Cardiovascular effects 482, 489
Cardiovascular functions 411
Cardiovascular monitoring and strategy 661
Cardiovascular status 727
Cardiovascular system 158, 159
Cardiovascular warning signs 664
Carrico index 236
Catecholamines 177, 504
Cellular respiration 17
Central chemoreceptors 27
environment of 27f
Central controller 11
Central nervous system injury 605
Central venous catheter 188
Central venous pressure 169, 683
role of 158, 162
Cerebral autoregulation 671
Cerebral palsy 103
Cerebral perfusion 176
Cerebral tissue hypoxia 159, 179
Cerebrospinal fluid 27
Charle's law 103
Chemoreceptors 27
types of 27f
Chest and abdomen, movements of 40
Chest compliance, effects of 154
Chest diseases 72
Chest expansion 266
Chest wall
compliance 63, 155, 634
elastic load 714
elastic recoil of 69, 70
elasticity of 70
oscillation, external 193
recoil pressure of 64, 64f
Circuit alarm, control 295, 297
Circuit compressible volume 242
Circuit, control system and 185, 194
Circuit ventilators, single 197
CMV mode, components of 362
CO2 exchange and oxygenation 653
CO2 of primary concern 642
Combined power ventilators 185187
Compressed gases 186
Congenital emphysematous lung 71
Congenital heart disease 97
Congenital pulmonary hypoplasia 71
Corticosteroids 620
Cough with airway suctioning 733
Cough, reduction in ability to 689
CPAP/PEEP 481
therapy 510, 512, 513
Craniocerebral trauma 383
Cuff leak test 729
Cuirass ventilator 192
Cycling synchrony 431
Cyst formation 637
D
Dalton's law 104, 104f, 105
Dead space 53, 608
causes of 564
functional 53
quotient 51
reduction of 181
unit 99, 99f
ventilation 43, 51, 51f, 102f, 286, 458, 511, 714
assessment of 58
Decaying exponential function 311, 315f
Decubitus ulcers 696
Deflection point, upper 508
De-pressurisation after opening expiratory valve 525f
Derecruitment pressure 487
Determine oxygenation 236
Dexamethasone 730
Diagnosing respiratory failure 565, 566f
Diffusion 105, 107
defect 103
Dipalmitoylphosphatidylcholine 74
Disease resolution 639
Disease, restrictive 86, 122, 247, 263
Disorder, restrictive 359, 390
Dissolved oxygen, importance of 220
Double circuit ventilators 198
Double closed loop 197
Drug monitoring and electrolytes 595
Dual controlled ventilation 360
Dynamic airway compression 84, 84f
Dynamic compliance curve, shifting of 329, 330f, 331
Dynamic equilibrium 105
Dynamic hyperinflation 579
Dysfunction, diaphragmatic 120
Dysphagia, bulbar dysfunction 691
Dyspnoea 608, 690
E
Elastic fibre 60
destruction of 68
Elastic recoil 60, 70, 73, 485
of lungs 478, 478f, 479
Electrically powered ventilators 185, 186
Electrocardiogram 349
Electromagnetic poppet valve 200
Emphysema 111
End expiratory
occlusion test 524
pressure 265, 324, 477
End inspiratory
pressure 324
plateau 327
End-organ hypoxia 569
Endotracheal intubation 582
Endotracheal tube 202
obstruction 299
internal diameter of 85
EPAP/CPAP/PEEP, effects of 453
Etomidate 583
Eucapnic ventilation 481
Exacerbation of COPD 607
Exhalation, active 553, 553f
Exhaled end-tidal carbon dioxide tension 305
Exhaled gas alarms 305
Exhaled minute ventilation alarm 392
Exhaled oxygen tension 305
Exhaled tidal volume 300, 392
Expiration 18, 19, 20f
muscles of 21
slower 84
sufficient time for 275
time 279
Expiratory flow graphics 538, 538f
Expiratory flow rate 253, 541, 577
Expiratory force, maximum 689
Expiratory period, short 181
Expiratory reserve volume 115, 117
Expiratory tidal volume 66, 67
Expiratory time 271, 530, 530f
alarm 304
decreased 528
optimisation of 588
Expiratory trigger variable 425f
Expired minute volume 285
Exponential curve 309, 309f
Extra-alveolar vessels 174, 495
Extracorporeal membrane oxygenation 646
Extrathoracic pressure minus intrathoracic pressure 489
Extravascular water 482
Extrinsic lung restriction 71
Extrinsic PEEP 649
Extubation, failed 731
F
Faster rise time 359, 376
Fibrosis 71
Fick's equation 93
Fick's law of diffusion 26
Flow control valves 185
Flow patterns, types of 254, 254f
Flow synchrony 431
Flow time waveform 314f
Flow trigger 348
Flow waveform 253, 314
Fluid dynamics within lungs 626
Fluid SOL layer 8
Frank Starling mechanisms 163
G
Gas down tube 415f
Gas exchange 508, 634, 689, 706, 707, 726
components of 106
efficiency 659
failure 735
unit 98, 99f
zone 118
Gas flow 428
Gas laws 103
Gas solubility 106
Gas transport 17, 30
and exchange zone 483f
Gastrointestinal bleeding 159, 177
Gastrointestinal distension 159, 177
Gastrointestinal functions 177
Gay-Lussac's law 103
Glasgow coma score 675
Glucocorticoids 600
Graham's law 104
Guillain-Barré syndrome 191, 688, 690692, 697
H
Haemodynamic effects of PEEP 682
on intracranial pressure 682f
Haemodynamic instability 622
Haemodynamically stable patient 703
Haemoglobin concentration 230
Haemoglobin desaturation 569
Haemoglobin oxygen equilibrium curve 222
Haemoglobin versus dissolved oxygen 228
Haemoglobin, reduction in 229
Haemorrhage 168
Hagen-Poiseuille's law 82, 83
Head injury, weaning from severe 686
Head/brain injury, mechanical ventilation in 675
Heat moisture exchangers 208
Heated humidifier 208
Henry's law 104, 220
Hepatic and gastrointestinal functions 505
Hepatic function 178
Hepatic vascular resistance 178, 504
Hernia, diaphragmatic 71
Heterogenecity in distribution of gas 635
Heterogeneous process 630
Heterogenous lung disease 283
High compliance under artificial ventilation 72f
High exhaled tidal volume 302
High flow rate 249
High frequency oscillation 193
chest wall 193
High frequency range 392
High impedance 359, 391
High inspiratory flow 376, 377
rates 260, 275
High lung compliance 155
High minute volume alarm 302
High peak pressure alarm 297
High pressure 393
alarm 269, 383
High ventilatory rate 57
High ventilatory requirement 263
Hooke's law 69
Hormonal changes 498
Humidification 206
Humidifier
simple 207
types of 207
Hydration 579, 596
Hypercapnia 288, 570, 571, 609
and acidosis and/or hypoxaemia 690
dangers of 47
on brain vessels 672
Hypercapnic acidosis 596
Hypercapnic respiratory failure 562, 570, 580, 735
Hyperinflation and intrinsic PEEP 611
Hyperventilation 159, 179, 285, 676, 678
duration of 678
Hypocapnia on brain vessels 673
Hypokalaemia 604
Hypoperfusion 35
Hypophosphataemia 159, 179
Hypotension 603
prone for severe 582
Hypoventilation 97, 113, 159, 179, 233, 286
Hypovolaemia 493
and cardiac dysfunction 491
Hypoxaemia 102, 112, 120, 159, 179, 519, 569, 571, 572, 575
causing 496
correction of 102
mechanism of 120
postoperative 518
Hypoxaemic failure, pathophysiology of 565
Hypoxaemic respiratory failure 564, 570, 735
causes of 565
Hypoxia 113, 568, 676
causes of 575
depresses cell 568
signs of 113
Hypoxic pulmonary vasoconstriction 520
depression of 121
I
Inadequate oxygenation 570
Infants and children 435
Infection 705
Inflammatory oedema 661
Inflation volume
during pressure ventilation, determinants of 244f, 266f
in pressure ventilation, determinants of 244
Inflation, degree of 62
Inflection point, lower 508
Inhaled air, humidification of 4
Inhaled bronchodilators first line therapy 620
Inhaled corticosteroid 601
Inspiration 18, 19
and derecruitment during expiration 486f
beginning of 348
muscles of 21
sufficient time for 274
Inspiratory flow 274, 321f, 379, 548f
patterns 247
rates 252, 261, 274, 373, 374, 528, 536, 539, 648
types of 376
Inspiratory muscle overload 580
Inspiratory pause 540, 540f
time 281, 283
Inspiratory plateau 281
Inspiratory pressure 267, 357f, 388, 389f, 424, 424f, 711
alarm 392
Inspiratory rise time 356, 357f, 358, 375f, 376f, 389f, 421, 421f
in pressure support breath 423f
Inspiratory slope 356
Inspiratory time 57, 235, 252, 257, 274, 392, 528, 648
alarm 304
duration of 274, 275
prolongation of 275
Inspiratory volume-pressure curve 508
Inspiratory volume-time waveform 311f
Inspired gas alarms 304
Inspired gas temperature 305
Inspired oxygen
concentration 304
tension 40, 110
fraction of 707
Insufficient alveolar ventilation, causes of 40
Intercostal muscle 21
tone 71
Intermittent abdominal pressure ventilator 194
Intermittent mandatory ventilation 403
Intermittent positive pressure ventilation 74, 134, 362
Internal intercostal muscle 21
Internal pneumatic circuit 197
Internal respiration 3, 17, 36
Interstitial fluid 29
Intra-abdominal pressure 159, 177, 494
Intracellular metabolism 41
Intracranial hypertension 678
Intracranial pressure 671, 672f, 676, 682
monitoring 684
Intrapleural pressure 19, 22, 33, 148, 158, 160
importanance of 160f
Intrapulmonary gas distribution 411
Intrapulmonary pressure 22, 149, 239
reduction of 180
Intrapulmonary shunt 89
fraction 88
or shunt fraction 511
Intrathoracic pressure 159, 162, 176, 489, 490, 500
Intravenous aminophylline 600
Intravenous bronchodilators 599
Intravenous magnesium sulphate 602
Intravenous salbutamol or terbutaline 599
Intrinsic positive end-expiratory pressure 521, 609
or auto-PEEP 521
Intubation and ventilation 581
IPAP and EPAP 453
effects of 453
Iron tank 191, 192
Ischaemia 504
J
Jugular bulb venous oxygen saturation 684
K
Ketamine 583, 585, 586
Kyphoscoliosis 322
Kyphosis 72
L
Lactic acidosis 605
Laminar flow 79, 79f
Laplace's formula 76
Laplace's law 75, 76f
Large tidal volume 57
Larynx 3, 5
Light emitting diode 294
Light's criteria 634
Liquid ventilation 646
Liver 178
Loop system, closed 196
Low tidal volume 249
causes of 245
significance of 173
Low total muscle mass 73
Low volume 393
alarm 383
Lower frequency range 392
Lower tidal volume 359
Lung 3, 247, 263, 267, 323, 378, 628f
and chest wall 493
BIPAP ventilation 442f, 643f
capacity 116, 117
compartment model of 309, 310f
compliance 248, 493, 511, 511f
disease
restrictive 71, 135, 565
states of 68
elastic
loads 714
recoil of 70
tissue of 70
emptying 519
inflation of 323, 323f, 619
positive pressure 493
injury 519, 587
acute 516
transfusion related acute 679
ventilator associated 678
mechanical properties of 244
mechanics, monitoring of 323
pathology, presence of 233
pressure volume curve of 132, 132f
protective inflation volumes 247
recoil forces 487
recoil pressure of 62, 63f
recruitment 642
manoeuvres 655, 656
resection 249
volume 81, 114, 115f, 117f, 173, 480, 480f
and alveolar vessels 173f
and capacities 114, 116, 688
water 660
with no air trapping 523f
M
Magill system 57
Magnesium sulphate 602
Mean airway pressure 234, 234f, 265, 491
reduction of 181
Mechanical breath 536, 536f, 537, 537f, 544, 544f
of volume control ventilation 536f
synchronisation of 460
Mechanical ventilation 85, 308, 367, 481, 572, 573, 586, 615, 622, 667, 718
controlled 360
goals of 571, 572
in ARDS 654
in GBS 692
initiation of 689
lower frequency of 458
noninvasive 612, 640
weaning from 698, 734
Meconium aspiration syndrome 284, 291
Memory, random access 202
Methaemoglobinaemia 227
Methylprednisolone 663
Microatelectasis 90, 91
Microprocessor controlled ventilator, operation of 202f
Midazolam 585
Minute alveolar ventilation 39, 49, 286
Minute ventilation 38, 44f, 49, 50, 51, 58, 274, 285, 382, 590, 681, 710
Minute volume 38
alarm 300
calculation of 285
measurement of 285
Misconception regarding weaning 700
Mitral stenosis 71
Mixed venous blood 89
Mixed venous oxygen saturation 216, 218
importance of 217
normal values of 217
Monitor ventilatory status 50
Motion, equation of 203, 203f, 204
Mouth pressure 61, 148, 239, 265
Mucous layers 7
Multiorgan dysfunction syndrome 631
Multiorgan failure 631
pathogenesis of 632f
Muscle fibres, arrangement of 70
Muscle pressure 204
Muscle relaxation 588
Muscle weakness 714
classification of 691
Muscular disorders 737
Myasthenia gravis 691
Myasthenic crisis 691
Myocardial stunning 604
N
Narcotics 685
Nasal cavity 3
functions of 4f
Nebulised bronchodilators 598
Nebulised ipratroprium bromide 599
Nebulised β2 agonist 598
Neck, flexion and extension of 54
Neural and muscular components 14f
Neural conduction 736
Neurogenic pulmonary oedema 675
Neurohormonal mechanism affecting kidney function 498
Neurological conditions ventilatory support 690
Neuromuscular blocking agents 584
for intubation 583
Neuromuscular blocking drugs 583
Neuromuscular disease 55
with respiratory impairment or failure 687
Neuromuscular dysfunction 735
Neuromuscular respiratory failure 690f
Neutrophils 633
Nitric oxide 657
Non-cardiogenic pulmonary oedema 111
Non-cardiorespiratory effects of PEEP 482, 497
Non-conventional ventilation 645
Noninvasive positive pressure ventilation (NPPV) 594, 612, 726
in asthma 594
in COPD 613
treatment of 613
Noninvasive ventilation 476, 573
Non-ossified chest wall 73
Non-ventilated alveoli 564
Nutrition 704
O
Obstructive diseases 86, 122, 247, 263
Obstructive pulmonary disease, chronic 124
Obstructive ventilation
disorder 72
defects 121
Occlusion pressure 712, 713f
Occult-PEEP 521
Oesophagus 178
Ohm's law 77
Opioids 585
Optimise oxygen demand 659
Oral cavity and oropharynx 3
Oral intubation 676
Organ dysfunction syndrome 661
Oscillatory ventilation
high frequency 645
in TBI 683
Osserman's scale 691
Overdistension 519
or synchrony, prevention of 590
Oxgen gas mixture 730
Oxygen 187, 482, 487, 599
administration 596
binding capacity 220
binding curve 222
concentration alarm 305
concentration, fractional inspired 213
consumption 218, 364
delivery 494, 510, 566
and consumption 567
reduced 575
to cells 566
diffusion 108
dissociation curve 222, 222f, 224, 225f, 226
flux 93
in blood, partial pressure of 513
partial pressure of 222
saturation 221f
therapy 74, 617
to cells, delivery of 566
toxicity 639
mechanism of 231
transport system of 213
transport, failure of 567
uptake, failure of 568
Oxygenation 463, 463f, 572, 727
criteria 707, 708
failure 113, 459
causes of 113
goal 668
inadequate 561, 575
Oxyhaemoglobin 221
P
PaCO2, changes in 672
Parenchymal lung injury 635
Parenchymal respiratory failure 666
Partial ventilatory support 206
Peak airway pressure 265
Peak alveolar pressure 278f
Peak inflation pressure, desired level of 252
Peak inspiration pressure 353
Peak inspiratory flow 356
rate 252, 257, 258, 267
Peak inspiratory pressure 234, 265, 327
Peak pressure 67
alarm 299
Perfusion 100, 106, 107
Periciliary fluid layer 8
Peripheral gas exchange 17, 30
Peripheral tissues 223
Peritoneal dialysis 71
Permissive hypercapnia 641, 680
Permissive hypoxaemia 642
Persistent hypoxaemia, treatment of 234
pH goal 669
Pharmacological strategy in COPD 619
Phrenic nerve dysfunction 736
Physiological dead space 53
Physiological effects of PSV 426
PINSP and PEEP by value 459f
Pitfalls of autoflow 476
Plateau pressure 66, 239, 265, 283, 327, 328f, 508
for compliance measurement 525
goals 668
Pleural disease 71
Pleural pressure 23, 61, 154, 167
Pneumatic circuit 185, 197, 198
Pneumatic poppet valve 200
Pneumatic power, loss of 296
Pneumatically powered ventilators 185, 186
Pneumonectomy 54
Pneumonia 111
Pneumotaxic centre 13
Pneumothorax 111, 623
or fistula 441
Poiseuille's law 82, 414
Polyneuropathy, critical care 605
Positive airway pressure 720
Positive end-expiratory pressure (PEEP) 249, 355, 579, 609, 661
and CO2 exchange 513
and CPAP, application of 506, 506f
and FIO2 trial 651
and higher FIO2 table 651
and lower FIO2 668
and non-responder 510f
and tidal volume 640
and tissue oxygen delivery 514, 653
application to oedematous lung 483f
as responders and non-responders 509
effects of intrinsic 610
helps in ARDS 517
helps in COPD 518
in COPD patient, role of extrinsic 618
in presence of auto-PEEP 526, 527f
of compliance 509, 652
of oxygenation 509, 652
on bronchial circulation 497
on cerebral perfusion 502, 502f
on gastrointestinal functions 502
on GIT 503f
on hepatic function 504
on pulmonary vascular resistance 495
on PVR 496f
on renal function 497, 498f, 501f
on splanchnic vessels 503f
on systems 482
responders from non-responders 651f
role of 694
extrinsic 592
therapy 483, 484f
Post laparotomy 71
Potent cellular toxins 231
Power transmission and conversion system 185, 199
Pre-existing disease 124
Pressure alarms 269, 297, 383
Pressure amplitude between pHIGH and pLOW 458
Pressure and volume values 534
Pressure control 465f
breath 277, 400, 407, 408f, 469f
components of 387f
mode 314f
ventilation 386, 399, 401, 402f, 475, 540f, 555f, 556f, 643, 644f
components of 386
time cycle in 351f
waveforms in 373f, 387
Pressure cycle 353, 383
Pressure equalisation 524f
Pressure filling, negative 18f
Pressure in mechanical breath 545
Pressure limited 440, 471
ventilation 640
Pressure measurement in CVP 525
Pressure parameters 451
Pressure preset mode 481
Pressure regulated volume control (PRVC) 356
breath to breath analysis, functioning of 469
Pressure scalar 543, 549
of pressure 548f
of volume control mode 550f, 551f
Pressure support
breath 420, 420f, 428
to achieve targeted tidal volume 439f
ventilation (PSV) 401, 402f, 414, 415, 418, 426, 465f, 645
advantages of 436
classification of 419
with noninvasive ventilation in COPD 434
with SIMV 435
with CPAP 722
Pressure time waveform 312f, 315f
Pressure trigger 345, 345f
mechanism 345, 346f
Pressure ventilation 97, 156, 247, 259, 341, 672
negative 189, 193
setting tidal volume in 243, 243f
Pressure ventilator 185, 188
types of 190
Pressure versus volume control breaths 642
Pressure waveform 259f, 326f
Pressure, distending 478
Pressure, types of 147f
Prophylactic hyperventilation with normal intracranial pressure 677
Propofol infusion syndrome 685
Protein concentration 633
Proximal airway pressure 79, 326, 328, 328f
Pulmonary arterial blood 223
Pulmonary artery 164
Pulmonary capillary 24, 109f
blood flow 93
Pulmonary compliance 638
Pulmonary diseases, management of chronic obstructive 607
Pulmonary effects 482
Pulmonary embolus 56f
Pulmonary fibre, elasticity of 71
Pulmonary fibrosis 71, 111
Pulmonary fistula 97
Pulmonary gas exchange 16, 30
Pulmonary hyperinflation 580
Pulmonary hypertension 291, 637
Pulmonary oedema 71, 111, 249, 480, 573, 635
Pulmonary parenchymal failure 735
Pulmonary perfusion 35, 36f, 56, 97
Pulmonary pressures 61
Pulmonary vascular
congestion 71
resistance 166, 174
Pulmonary vein 164
Pulmonary ventilation 17, 20, 20f, 22
Pulmonary ventilatory failure 735
Pulsus paradoxus 158, 162, 168, 169
Puritan Bennett and bear ventilators 235
Q
Quadriplegia 688
R
Recoil pressure 60
Recruiting manoeuvres (RM) 640
Red status bar 294
Refractory hypoxaemia 513
Renal
function 174, 175, 704
venous outflow 159, 175
Renin angiotensin-aldosterone 176, 177
on renal system 499, 500f
Repetitive alveolar collapse expansion 172, 172f
Residual capacity 483, 579
functional 72, 106, 116, 117, 118f, 310
Residual volume 117
Respiration
accessory muscles of 21
anatomy of 3
external 3, 16, 30, 30f, 31
internal 30f
five stages of 16, 16f
phases of 81, 81f
Respiratory acidosis 609
Respiratory alkalosis 365, 412
Respiratory capacity 714
Respiratory centre
depression of 40
output 736
possible organization of 12f
Respiratory compensation, signs of 569
Respiratory control system, basic elements of 11, 11f
Respiratory cycle 271, 342f
Respiratory deterioration 332, 332f
Respiratory distress syndrome 247, 624
Respiratory drive, depressed 571
Respiratory exchange ratio 30, 31
Respiratory failure 48, 561, 689
before weaning 717
classification of 735
management of 576, 576f
symptoms of progressive 690
types of 561
Respiratory homoeostasis 31
Respiratory inductance plethysmography 349
Respiratory insufficiency 561
Respiratory mechanics 611
Respiratory minute
ventilation 271
volume 285
Respiratory monitoring 569
Respiratory muscles 21, 432, 481, 518, 518f
atrophy 365
fatigue 412, 567, 578
load 706, 713
paralysis of 40
reciprocal innervations for 13f
Respiratory organs 3
Respiratory quotient 30
Respiratory rate 40, 44, 84, 287, 302, 710
Respiratory support 570
Respiratory system 14, 158, 169
compliance 488, 713
model of 148, 148f
primary role of 26, 26f
recoil pressure of 65, 65f
Respiratory values, normal 126
Restrictive and obstructive defects 121, 122f
Reynolds's number 80
Rhabdomyolysis 605
Right main bronchus 6
Rising exponential function 310, 311f
Robin Hood phenomenon 673
S
Scalar graphics 387
analysis of 534
Scoliosis 72
Shunt equation, classic physiologic 94, 95
Shunt unit 99, 100f
Siemens and Drager ventilators 235
Small intestine and colon 178
Smaller volumes 115
Smoke inhalation 111
Solenoid valve 200
Spinal cord abnormalities 736
Splanchnic hypoperfusion 502
Spontaneous and mechanical breath 547f
Spontaneous breathing 152, 158, 159, 339f, 406, 410, 535, 535f, 539f, 543, 544f
pattern 426
trials 702, 706, 715, 716
with CPAP and pressure support 419f
Spontaneous respiratory rate 710
Spontaneous tidal volume 710
Spontaneous ventilation 700, 701f
Spring, elastic resistance of 128f
Sputum analysis 581
Static and dynamic compliance curves, shifting of 331f
Static compliance, calculation of 66
Steal phenomenon 673
Steep Trendelenburg position 119
Steroids 662
side effects 605
Stiff lungs 158, 258, 283, 322
Stomach 178
Stress amplification 649
Stress and strain, concepts of 635
Stress fractures 173
Stretch 637
injury 173
Structural resistance 132
Subatmospheric pressure 23
Superficial gel layer 7, 8f
Sympathetic stimulation 159, 175, 498
Sympathetic tone 569
Synchrony or dyssynchrony 430
Systemic corticosteroid 601
Systemic inflammatory response syndrome 631
Systemic inflammatory response, role of 678
T
Tachypnoea 480, 710
monitoring 303
Tank ventilator 190, 191f
Tension pneumothorax 71
Tetralogy of Fallot 90
Therapeutic hyperventilation 677
Thoracic compliance 525
Thoracic gas volume 123
Thoracic pump mechanism, abolition of 160f
Thoracic pump, negative 160
Thromboembolic disorders 696
Tidal volume 44, 55, 114, 242, 243, 373, 393, 452, 647, 654f, 681
and ventilatory rate 590
determinant of 152, 152f
during mechanical ventilation 238
normal correlation of 250f
Tissue 216, 228
metabolism 562
oxygen 575
resistance 86, 132
Tobin index 714
Toxic gases 9
Toxic levels 487
T-piece and ventilatory support 720
T-piece breathing 718
T-piece trial
advantages of 719
disadvantages of 719
terminated 719
Trachea 3, 5
Tracheostomy 730
collar 669f
timing for 621
tube 251
Transairway pressure 79, 150, 240, 324
Transalveolar pressure 63, 63f
Transmural pressure 24, 162
Transpleural pressure 64, 64f
Transpulmonary pressure 19, 24, 33, 134, 189, 639
and lung volume 639f
gradient 33, 33f, 203f
Transrespiratory pressure 24, 134, 203f, 205
Transthoracic pressure 65, 150, 241
Transthoracic vascular pressure gradient 489f
Traumatic brain injury 673
management of severe 674
Traumatic spinal injury 688
Trendelenburg position 119
Trigger mechanical breath 580
Trigger sensitivity 343, 369, 618
Trigger synchrony 431
Trigger timeout 476
Trigger, causes of 303
Tromethamine 597
Tube compensation 724
Tuberculosis 103
Turbulent flow 80, 80f
U
Upper airway 3
pressure 148, 239
Upper motor neuron disease 71
Upper oxygen concentration alarm 305
V
Vascular filling pressures 620
Vascular lung tumours 97
Venous admixture 91
Venous back pressure 178, 504
Venous blood, normal mixed 223
Venous oxygen content 220
Venous oxygen saturation 495, 514
Venous return 159
Ventilation 16, 30, 32, 38, 42, 97, 100, 106, 464, 464f, 528, 611, 727
adaptive support 724
and perfusion
distribution of 98
imbalance 577
assist pressure controlled 616
bi-vent mode of 467f
common modes of 360f
controlled 10, 153, 158, 160, 206, 360
mandatory 362, 364, 367, 368, 370, 371
controlling minute 364
criteria 709
disorder 70
distribution of 38
failure 460
for chronic NMD, role of noninvasive 694
in acute exacerbation 519
interactive 474
inverse ratio 447, 644
mode of 243, 360, 680, 693, 695
noninvasive 664
perfusion in excess of 97
perfusion mismatch 608
and shunt 635
positive pressure 156f, 491
precautions at initiation of 582
pressure alarm 297, 297f
pressure controlled mode of 314
strategy 679f
in severe TBI 679
time parameters in 271
type of 664
wasted 286
with BIPAP 459, 460
without perfusion (dead space) 564
Ventilator assistance 612
Ventilator dependent patients, chronic 731
Ventilator dyssynchrony 644
Ventilator function, control 195
Ventilator graphic 533
representing flow triggering 347f
Ventilator induced lung injury 646, 647
Ventilator management in severe asthmatics 586
Ventilator parameter 268, 455, 469, 618, 680
Ventilator pressure 204
Ventilator sensitivity 343
Ventilator settings 616
Ventilator setup and adjustment 667
Ventilator strategy, change of 664
Ventilator support 641
breath, variables of 343f
Ventilator
components of 185
off 715
on 715
Ventilatory alarms 366
Ventilatory defects 121
Ventilatory demands 639
Ventilatory drive 706, 712
Ventilatory failure 47
pathophysiology of 562
Ventilatory frequency 247, 648
Ventilatory load 738
Ventilatory management in ARDS 638
Ventilatory mode 616
Ventilatory monitoring 661
Ventilatory muscle 717
function 428, 429
strength 706, 711
Ventilatory parameter 385, 385f, 438, 451f
with BIPAP ventilation 451
Ventilatory pattern, abnormal 684
Ventilatory pressure 380, 381f
types of 298
Ventilatory pump, failure of 571, 580
Ventilatory rate 391, 461f, 462f, 543
reduction of 529f
Ventilatory settings 664
in ARDS 646
in PSV 614
Ventilatory strategy 559, 594, 683
for ARDS 624
for neuromuscular diseases 687
for traumatic brain injury 671
in ARDS 641
in head/brain injury 675
Ventilatory support 572, 634, 638, 700
by BIPAP 446
Ventricle
left 492f
right 492f
Ventricular afterload, right 578
Ventricular interdependence 165, 166
bernheim effect 491
Ventricular septal shifting effect 166, 491
Vessels, types of 495
Viscomechanical dissociation 9f
Vital capacity 116, 689
Volaemic status initially 664
Volatile general anaesthetics 10
Volume alarms 300
Volume and pleural pressure 66
Volume assured pressure support 342
Volume control breath 277f, 400, 407f, 469f
Volume control mode 315, 548f
Volume controlled ventilation 282f, 321, 321f, 353f, 372, 378f, 380, 395, 555f
minimal flow in 379f
Volume cycle 352
in volume controlled ventilation 352
Volume infusion 662
Volume monitoring 300
Volume restriction 72
Volume scalar 552
Volume support 475, 724
ventilation 437
Volume trigger 349
Volume ventilation 247, 259, 341
setting tidal volume in 245, 245f
Volutrauma 158, 171
W
Warming inhaled air 4
Waste gas 26
Water vapour 105
Weanability, classification of 702
Weaning indices 706, 714
Weaning, criteria of 700
Weaning, failed 698
Weaning, primary goals of 701
Weaning, prolongation of 412
Weaning, stages of 699, 699f
Weaning, techniques of 717
Wedge pressure 633
Y
Yellow status bar 294
Z
Zero end expiratory pressure 355, 485f
×
Chapter Notes

Save Clear