Core Topics in Mechanical Ventilation Edited by Iain Mackenzie Index More Information

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Cambridge University Press 978-0-521-86781-8 - Core Topics in Mechanical Ventilation Edited by Iain Mackenzie Index More information

Index

Abdominal distension in lung elastance oxygen toxicity 270 incidence data 240 345, 346 patient assessment 118, 115–119, 120 laryngeal injuries 248, 247–248 Abdominal paradox 27 recruitment manoeuvres 118–119, left ventricular performance 273 N-Acetylcysteine 79–80, 81, 357, 358 131, 219 lorazepam 165 Acinetobacter baumanii, SDD for 260 trials (See ARDS net trials) lung injury, ventilator-associated (See Acute hypoxaemic respiratory failure ventilation management Lung injury, defined 115 HFOV 127–131, 305–306 ventilator-associated) Acute lung injury (ALI) IRV 125–126 maxillary sinusitis/middle ear blast injuries 212 liquid 228 effusions 246–247 hypoxaemia, PEEP management of modes 215–216 midazolam 165 124–125 overview 214 nasopharyngeal airways 243–245, infants/children 300–301 principles 214–215, 216 246–247 liquid ventilation 228 Acute respiratory failure (ARF) nasotracheal intubation 315 patient assessment 118, 115–119, clinical presentation 29 neurological function 277, 276–277, 120, 197 mechanisms of 24 278, 280 recruitment manoeuvres 131, 219 NIV 43, 49–50 (See also Non-invasive NMBAs 171, 176–177, 276–280 ventilation management ventilation (NIV)) NSAIDs 181 HFV 149–150 overview 24, 22–24, 25, 142 opioid agonists 180 IRV 125–126 Adaptive support ventilation® 113, 361 opioids 276–280 modes 215–216 Adrenaline 81 overview 21, 239, 241 overview 214 Adrenergic receptor antagonists 349, oxygen toxicity 270, 269–270 principles 214–215 348–349, 350 paralysis 176–177 Acute necrotizing myopathy 205, 205, Adverse effects/complications PEEP 125, 126, 198 356 analgesia 276–280 perforations 243 Acute quadriplegic myopathy artificial airway management 58, pharyngo-laryngeal dysfunction 247 syndrome (AQMS) 177 62–63, 72–73 pneumothorax 241–242 Acute renal failure 156 aspiration 242–243, 247, 266 propofol 165–166, 276–280 Acute respiratory distress syndrome aspiration pneumonitis 242–243, pulmonary vascular resistance (ARDS) 245 272–273 APRV therapy 110–112 barotrauma (See Barotrauma) reduction 245, 246 blast injuries 212 benzodiazepines 165, 276–280 regurgitation 242–243, 247, 266 causes 214 bronchopleural fistula 252–253, 255 remifentanil 276–280 CT assessment 265 cardiovascular effects 271, 272, 277 right ventricular performance 272, delirium in 169 cervical spine damage 245, 243–245 274 dornase alfa 79–80 dental/soft tissue/laryngeal 243 sedation 165–166, 245, 276–280 drugs for 81, 137 dexmedetomidine 166 sleep 276, 277, 278, 279, 349, high tidal volume ventilation in endotracheal intubation 58, 72–73, 348–349, 350, 384 153–154 240, 239–240, 242, 246 sufentanil 276–280 hypoxaemia, PEEP management of extubation, un-planned 249–250 swallowing dysfunction 247, 247 124–125 face/lips/oropharynx 245, 246 tracheal injuries 243, 249, 248–249 inertia/friction issues 347, 333–347 fentanyl 276–280 tracheostomy (See under lung contusions 219 gastrointestinal system 274–276 Tracheostomy) nitric oxide as therapy 139 hypotension/hypoxia 239–242 trauma 43

411

Index

Adverse effects/complications (cont.) oxygenation of, surface area in 122, AQMS (acute quadriplegic myopathy VAP (See Ventilator-associated 121–122 syndrome) 177 pneumonia (VAP)) pressure mechanics 5, 4–5, 9–11, 268 ARDS. See Acute respiratory distress venous return 271–272, 273 recruitment syndrome (ARDS) VIDD (See Ventilator-induced in lung elastance 346, 345–346 ARDSnet trials diaphragmatic damage (VIDD)) in muscle contraction 353 lung injury, ventilator-associated withdrawals 278, 276–278, 280 surfactant dysfunction 267, 265–267 263–265

Aerial transport issues in low PO2 13 surfactant in 6, 4–6, 9, 267 NMBA usage 171 Aeromedical transportation issues 290, V/˙ Q˙ ratios 15, 120–121, 136, PEEP 124, 125, 146, 216, 267–269 294, 293–294, 295 133–136, 139 permissive hypercapnia 153, 154,

Aerosol drug delivery ventilation inequality in low PO2 155 factors affecting 85 15–16, 17 ventilation modes 215 metered dose inhalers 83, 84 wall stress, inspiration and 266 ARF. See Acute respiratory failure (ARF) method selection 83 Amikacin 81, 256–257 Arginine 190 nebulizers (See Nebulizers) Aminoglycosides 256–257 Aripiprazole 170–171 overview 81, 80–81, 82 Aminophylline 201, 360 Arterial blood gas measurement 29–30 AIDS 359–360 Aminosteroid NMBA agents 174, Arterial oxygen content, calculating 119 Airway collapse, risk factors 1–4 175–176 Artificial airway management, lower Airway development, upper 297 Anaesthesia, history of active HMEFs 74 Airway obstruction pneumothorax 392–394 aerosol drug delivery 80–83 children 298, 306 sealed airway 390–392 complications 72–73 (See also Heliox 232 Anaesthetic ventilator modes 88–90 Adverse effects/complications) hypotension/circulatory collapse Analgesia HMEFs 74, 75 205–206 acetaminophen 180 hot water humidifiers 74–75 management 311, 363, 362–363, 364 adverse effects 276–280 humidification 74 pathophysiology 197, 196–197, 198, as delirium risk factor 168–169 mucoactive agents 78–80 363 monitoring 178 overview 72–73 pneumothorax 206–207 NSAIDs 180, 181 tracheobronchial suctioning 75–78 problems associated with 196, 203 opioid agonists 168–169, 179, tube exchange 83 tracheostomy 78, 311, 312, 319 178–179, 180 tubing, monitoring 83–85 tracheostomy/tracheobronchial overview 178 Artificial airway management, upper suctioning 78 Anatomical dead space defined breathing system care Airway patency 363, 362–363, 364 143–145 cuff deflation 71 Airway pressure, increasing 122, 123 Androgens 359–360 cuff inflators, manual 70 Airway pressure release ventilation Antadir 376–377 cuff pressure control 71, 69–71 (APRV) Anti-cholinergic drugs oral hygiene 72 applications of 122, 123 asthma/COPD 200 securing, of tube 69, 67–69 described 110–112, 113 mucus production, decreasing 80 sub-glottic secretion drainage 72, inspiratory time prolongation by primary post-ventilation apnoea 71–72, 262 126–127 334–336 Combitube 56, 57 Airway protection 364, 365 Anti-depressants 348–350 complications 58, 62–63, 72–73 (See Airway resistance, in infants/children Anti-fibrinolytics 137 also Adverse 298–299 Anti-pyretics 148 effects/complications) Alfentanyl 62–63 Antibiotic resistance 261 cricoid pressure application ALI. See Acute lung injury (ALI) Anticholinesterases 334–336 technique 63 Almitrine bismesylate, for V/˙ Q˙ Antimuscarinics 81 drugs/venous access 62–63 mismatch 137 Antipsychotics 170–171 endotracheal tubes (See Alternative recruitment hypothesis 254 Anxiety 349, 348–349, 350 Endotracheal intubation) Alveolar-arterial difference calculation APACHE II model, hyperoxia 270, 271 equipment 59, 60–61 116–119 Apnoea indications 58 Alveolar dead space defined 143–145 in infants/children 299–300 LMAs 56, 57

Alveolar shunts in low PO2 14–15 primary post-ventilation 336, monitoring 59 Alveoli 334–336 nasopharyngeal airways 55, 56 development of 296–297 secondary 340, 339–340 oropharyngeal airways (See diffuse haemorrhage 137, 137, 139 ventilation 106 Oropharyngeal airways) functional anatomy 3, 4 Aprotinin 137 overview 54, 55 minute volume increase/pH 350, APRV. See Airway pressure release oxygenation 58–59, 60, 61, 62 350, 351 ventilation (APRV) placement 57–58

412

Index

suction apparatus 61–62 standard therapy 199–200 Bjørneboe, Mogens 397–401 tilting bed/trolley 61 metabolic acidosis/hypercapnia in Blast injuries tube cutting technique 66 155–156 barotrauma 213, 216–217 ventilator 63 muscle fatigue and 24–25 bronchopleural fistula 213 Artificial lungs 227–228 pneumothorax 206–207 classification 213 Aspiration Astrup, Poul 397–401 clinical presentation 212, 213–214 as adverse effect 242–243, 247 ATC (automatic tube compensation) diagnosis 211–212 foreign body, in infants/children 297 114 explosions, physics of 210 gastric residual volumes and 188–189 Atelectasis 23–24 incidence 212–213 lung transplantation 224–225 Atracurium outcomes 217 meconium aspiration syndrome 81, AQMS and 177 primary described 210–211, 213 303–304 overview 174–175 quaternary described 211 pulmonary, risk factors 242 properties 175 radiographic findings 213 tidal volume and 266 study data 174 secondary described 211 transportation issues 287 Auer, J. 393 sucking chest wounds 213 VAP transmission via 257, 258–261 Augmented diffusion 305–306 systemic effects of 217 Aspiration pneumonitis 242–243, 245 Automatic tube compensation (ATC) tertiary described 211 Assessment, of need 114 treatment arterial blood gases 29–30 Automode® 113 ECMO 217 availability principle 22 Availability principle 22 fluid administration 217 clinical 23, 29, 25–29, 30, 144 overview 214 diaphragmatic function 27 β-blockers 348–350 PIP/permissive hypercapnia

hypercapnia 22–25, 26 Barometric pressure issues in low PO2 216–217 lung volume measurement 27 13 ventilatory strategy, long-term 214 maximal inspiratory pressure 27 Barotrauma Blast waves 210 neurological disorders 30 blast injuries 213, 216–217 Blast wind 210 overview 21 causes 253 Blast zone anatomy 211 patient categories 22–25 clinical presentation 250, 251 Blease, John 395, 394–395 pulse oximetry 28, 27–28, 29 permissive hypercapnia and 154 Blease Pulmoflator 394–395 quality/length of life principle 22 pneumothorax and 250–253 Blood, gas exchange 9–11

rate/tidal volume 26–27 risk factors 101, 126 Blood perfusion in low PO2 16–17, 18 reversibility principle 21–22 RMs and 131 Bohr effect 146–147 support, goals of 25 Basiliximab 224 Bohr equation 145 thoraco-abdominal motion 27 Beecher, Henry 393–394 Both, Edward 396–397 Assist pressure control mode 108, 109 Beneficial studies, ventilation modes Both Respirator 396–397 Assist volume control mode 108, 109 215–216 Bott COPD/NIV study data 45 Asthma Benzodiazepines. See also specific agents Brauer, Ludolph 393 acute necrotizing myopathy 205, 205 adverse effects 165, 276–280 Breathing airflow obstruction, artificial airway management 62–63 expiratory cycling 90–91 pathophysiology 196–198 delirium treatment 170, 348–350 features of 89, 88–89, 90, 95 circulatory collapse 206, 205–206 history of 310 inspiratory cycling described 90 clinical presentation 198, 199 primary post-ventilation apnoea muscle contraction in 351–352 management 336, 334–336 periodic 299, 299, 300, 340 aminophylline 201 as sedatives, overview 163–164, 178 respiratory cycle 89, 88–89, 90 bronchodilators 149 withdrawals 278 spontaneous 90, 95, 105, 107 cysteinyl leukotriene modifiers 201 Benzylisoquinolinium NMBA agents triggered 90, 94–95, 105, 107 dornase alfa 79–80 174–175 Breathing system care follow-up 207 Bert, Paul 269 cuff deflation 71 glucocorticoids 80 Beta 2 adrenergic agonists cuff inflators, manual 70 Heliox 231, 234 asthma/COPD 137, 199–200, 202 electronic cuff pressure controller 71, lactic acidosis 200–201 bronchospasm 81 70–71 magnesium sulphate 201 gastroesophageal reflux 274–275 foam-filled HVLP cuff 70 mechanical ventilation 203, in hypercapnia management 149 Lanz inflation balloon 70, 71 202–203, 204 lactic acidosis 200–201 oral hygiene 72 NIV 49, 201–202 Beta-lactams 256–257 securing, of tube 69, 67–69 PEEP 204 Bicarbonate retention 156 sub-glottic secretion drainage 72, sodium cromoglycate/nedocromil BiPAP (bi-level pressure support) 378 71–72, 262 sodium 201 Bispectral index (BIS) monitor 162 Brochard COPD/NIV study data 45

413

Index

Bronchi/bronchioles, functional Catheters high airways resistance, factors anatomy 3, 3, 4 endotracheal 61–62, 76 affecting 106 Bronchiolitis 304–305 pressure issues 76, 77 hypercapnia, oxygen-induced 35–36 Bronchodilator therapy 149 TGI 151, 150–151, 152 management Bronchopleural fistula 252–253, 255 tracheobronchial 76–77 aminophylline 201 Bronchospasm 26, 81 withdrawal 77 CPAP vs. NIV 43, 201–202 Burns CCV (critical closing volume) 268 cysteinyl leukotriene modifiers incidence/pulmonary complications Central fatigue 356–358 201 217–218 Cervical spine damage 245, 243–245 follow-up 207 overview 217 Chest drain, insertion technique 254 glucocorticoids 80 oxygen delivery methods 33–34 Chest trauma Heliox 231, 234 transportation issues 287 blunt, ventilation strategies 219 lactic acidosis 200–201 treatment 218, 218 diagnosis 219 magnesium sulphate 201 BURP manoeuvre 60–61 drain insertion technique 254 mechanical ventilation 203, 204, Buscopan (hyoscine butylbromide) 80 pathogenesis 219 204, 205 Buspirone 348–350 Chest wall development 297–298 NIV 49, 201–202, 380–381, 385 Cheyne-Stokes breathing 339–340 sodium cromoglycate/nedocromil Cabin altitude 294–295 Children sodium 201 Caffeine, for apnoea in infants/children airway development, upper 297 standard therapy 199–200 299–300 airway obstruction 298, 306 muscle fatigue and 24–25 Calcineurin inhibitors, post-transplant bronchiolitis 304–305 NIV issues 46–47 immunosuppression 224 cardiovascular system development NIV study data 43–44, 45, 45, 46, CAM-ICU (Confusion Assessment 298 380–381, 385 Method for the ICU) 168, chest wall development 297–298 pneumothorax 206–207 167–168, 169 choanal atresia 300, 302 therapy targets 384 Cannulae, ECGE 152–153 congenital diaphragmatic hernia Ciaglia, Pasquale 322 Capnography 59 302–303, 304, 305–306 CIM (critical illness myopathy) 356 Carbapenems 256–257 consent issues 307–308 CIP (critical illness polyneuropathy) Carbicarb 156 control of breathing 299–300 353–355 Carbocisteine 79–80 CPAP 289–290, 300 Ciprofloxacin 256–257 Carbon dioxide CPAP/NIV 301–302 Circulatory collapse 206, 205–206 balance, arterio-venous 143, 146–147 dornase alfa 79–80 Cisatracurium children/infants, sensitivity to head injuries 306 overview 174–175 299–300 HFOV 305, 305, 306 properties 175 clearance HFV 150 study data 172–173, 174 alveolar/pulmonary 14–15, 19, humidification 307 vs. vecuronium 175–176 143–146 hyaline membrane disease 136 Clarithromycin 80 dead space 18, 143–145 liquid ventilation 228 Clonidine 278, 279 ECGE 152–153 lung development in 296–297 CMV. See Continuous mandatory Heliox 231 lung mechanics in 300–301 ventilation (CMV) by HFOV 127–131 muscle fatigue in 297–298, 307 Co-operative binding 117 by HFV 150 nitric oxide therapy 304 Colistin 81 overview 17–20, 142, 156–157 oxygenation assessment in 118 Combitube 56, 57 by PEEP 145–146 permissive hypercapnia 301 Compound unit conventions xiv, xiv sodium bicarbonate and 154–156 physiology 299, 298–299 Confusion Assessment Method for the tidal volume/frequency 145, sepsis 307 ICU (CAM-ICU) 168, 167–168, 347–351 ventilation of 301 169 overview 142 Chlordiazepoxide 310 Congenital diaphragmatic hernia production 143, 144, 148 Chlorhexidine 261 302–303, 304, 305–306 transport, in blood 146–147, 199 Choanal atresia 300, 302 Consent issues, infants/children Carbon dioxide narcosis 28, 147 Chronic obstructive pulmonary disease 307–308 Cardiogenic pulmonary oedema (COPD) Continuous mandatory ventilation CPAP 39–43, 289–290 acute necrotizing myopathy 205, 205 (CMV) hypoxaemia and 23 airflow obstruction, described 104, 108–112 NIV study data 49 pathophysiology 196–198 post-transplant 222–223 NIV vs. CPAP 42–43 in ARF 24 Continuous positive airway pressure Cardiovascular system development circulatory collapse 206, 205–206 (CPAP) 298 clinical presentation 198–199 administration 37–38, 39

414

Index

airway circuit pressure fluctuations overview 88 primary post-ventilation apnoea 40 Cycloproprane 392 336, 334–336 in APRV 126–127 Cyclosporine, post-transplant as sedative 162 bi-level mode 109–110, 111 immunosuppression 224 Diffuse alveolar haemorrhage bronchiolitis 304–305 Cysteinyl leukotriene modifiers, described 137, 137 cardiogenic pulmonary oedema asthma/COPD 201 RM therapy 139 42–43 Cystic fibrosis 79–80, 81 Diffusion children 300, 301–302 Cytokines 153–154, 265–267, 270 augmented 305–306 circuit/reservoir 40 Cytopathic hypoxia 120 coefficient, in oxygenation 132

clinical use 42 limitation in low PO2 14, 10–14, 16 COPD 43, 202, 204–205 Daclizumab 224 in oxygen transfer 10, 117 cuff deflation 71 Dalziel, John 395–397 oxygenation, distance in 121, 133 indications/contraindications 30, 44 Day-time somnolence 43 Dornase alfa 79–80, 81 interfaces 39 De-cannulation Double cannula tubes 326–327 OSAHS 42, 43 airway patency 363, 362–363, 364 Doxacurium 175 overview 37–39, 44 airway protection 364, 365 Drager¨ Oxylog 3000 289, 290, 291 physiological effects 41, 39–41, 42 indications 362 Drinker, Philip 396, 396 pneumonia 43–44 protocol 368, 367–368 Drinker Respirator 396–397 post-operative patients 44 secretion clearance 366, 364–366, Drugs/venous access 62–63 in transportation 289–290 367 Duchenne muscular dystrophy (DMD) trauma 42, 43 as tracheostomy complication 377, 379–380 Contractility, diaphragmatic 339, 360 318–319 Duty cycles 88–90 Conversion factors, pressure xiv Dead space Dynamic compliance 8, 7–8, 9 Cor pulmonale 43 calculation of 18 Dynamic hyperinflation 196–198, Corticosteroids elements of 143–145 206–207 AQMS 177 infants/children 300–301 extubation protocol 364, 365, 367 TGI and 151, 150–151, 152 Eaton–Lambert syndrome 355 inflammation 81 weaning and 351 ECCOR 152 neuromuscular conduction Delirium ECGE (extra-corporeal gas exchange) dysfunction 355 benzodiazepines 170, 348–350 152–153 Coughing in secretion clearance defined 167 ECMO. See Extracorporeal membrane 364–367 dexmedetomidine 164–165 oxygenation (ECMO) CPAP. See Continuous positive airway diagnosis 168, 167–168 Edema. See Oedema pressure (CPAP) haloperidol 170–171 EELV. See End-expiratory lung volume Crafoord, Clarence 393–394 outcomes 169, 349, 348–349, 350 (EELV) Cricoid pressure application technique prevention/treatment 169–171 Electrolyte imbalance disorders 63 risk factors 168, 168, 169, 349, 355–358 Cricothyroidotomy 327–328 348–349, 350 Electronic cuff pressure controller Critical care patients and ventilation weaning 348–350 70–71 carbon dioxide production in 143 Dental plaque in VAP transmission Emphysema 296–297, 318 endotracheal intubation 58, 57–58 260–261 End-expiratory lung volume (EELV). energy requirements 184–185 Deoxyhaemoglobin See also Functional residual over-feeding 185 in CO2 transport 199 capacity (FRC) protein requirements 186 Depolarizing NMBA agents 174 defined 9 sedation of (See Sedation) Depression 349, 348–349, 350 diaphragmatic contractility 339, 360 tube exchange 83 Dexmedetomidine gas-trapping and 346, 338–346, 347 Critical closing volume (CCV) 268 adverse effects 166 inspiration effects on 266, 338 Critical illness myopathy (CIM) 356 in delirium management 168–169 Endocrine disorders 355–358 Critical illness polyneuropathy (CIP) overview 164–165 Endotracheal cuff puncture 316–318 353–355 properties 163 Endotracheal intubation CTrach LMA 56 Dextran 79 additional channel tubes 66–67, 68 Cuff inflators, manual 70 Diaphragm adverse effects/complications 58, Cuffed tubes 325–326 contractility 339, 360 72–73, 240, 239–240, 242, 246 Cyanide poisoning 120 function measurement 27 armoured/reinforced tubes 66–67, Cycle time 88 hernia, congenital 302–303, 304, 69 Cycling 305–306 asthma 49 expiratory 90–91 tension-time index 359 bronchiolitis 304–305 inspiratory, described 90 Diazepam catheter issues 61–62, 76

415

Index

Endotracheal intubation (cont.) Expiratory positive airways pressure Fleisch pneumotachograph 233–235 COPD 44–45 (EPAP). See also Continuous Flow-dependent expiratory cycling CPAP vs., study data 42–43 positive airway pressure (CPAP) 90–91, 93 critically ill patients 58, 57–58 airway pressure measurement 38 Flumazenil 164, 334–336 cuff types 66, 70 NIV vs. CPAP 198, 202 Fluoroquinolones 256–257 defined 54, 55 optimal level issues 47 Foam-filled HVLP cuff 70 difficult, incidence data 240 Expiratory time described 88–90 Foreign body aspiration, in HMEFs 74, 75 Explosions, physics of 210 infants/children 297 indications 58 See also Blast injuries Fractional inspired helium infants/children 298–299 Extracorporeal gas exchange (ECGE) concentration (FiHe) 230, NIV weaning, study data 47–48 152–153 232–234 occluded tubes 65 Extracorporeal membrane oxygenation Fractional inspired oxygen one lung ventilation tubes 66–67 (ECMO) concentration (FiO2) oral vs. nasal 63–65 blast injury treatment 217 aeromedical transportation placement, confirmation signs interventional assist devices 227 calculations 294, 294, 295 242 post-transplant 226–227 delivery 33 propofol 164 principles 227 factors affecting 12–13, 28, 27–28, 29 PVC cuffs/tubes 314, 324 Extubation Heliox 233, 232–233, 234 re-intubation, post-NIV 48–49 airway patency 363, 362–363, 364 HFOV settings 127–131 securing, of tube 69, 67–69 airway protection 364, 365 notation xiii size/length issues 65, 65, 66 CNS pathologies in 351–352 oxygen toxicity and 270, 271 sub-glottic secretion drainage 72, failed 368 partial pressure of inspired oxygen 71–72, 262 indications 362 132 suction arrangement 78 protocol 364, 365, 367 recruitment manoeuvres 131 trauma 43 secretion clearance 366, 364–366, France, HMV in 376–377 tube cutting technique 66 367 FRC. See Functional residual capacity tube exchange 83 un-planned, as adverse effect (FRC) tube resistance, compensation for 249–250 Frenckner, Paul 393–394 114 Frog breathing (glossopharyngeal tube types 64 Face masks breathing) 374–375 tubing, monitoring 83–85 CPAP 39 Functional residual capacity (FRC). See Engstrom,¨ Carl-Gunnar 397, 398 overview 33–35 also End-expiratory lung volume Enteral nutrition oxygen delivery 34, 36, 50 (EELV) cessation, indications 189 FastrachTM (intubating) LMA 56 asthma/COPD-related airflow gastric residual volumes 188–189 Fatigue. See Muscle fatigue obstruction 197, 196–197, 198 indications 187 Feeding, practical aspects. See also CPAP effects on 39–42 interruptions 189 Nutritional support defined 9 overview 186 enteral/parenteral (See Enteral diaphragmatic contractility 339, 360 and parenteral 187–188 nutrition; Parenteral nutrition) infants/children 300–301 vs. parenteral 187 gastric emptying, delayed 189 Furosemide 153 pre- vs. post-pyloric 188 gastric residual volumes 188–189 protocols 188 interruptions 189 Gallbladder, ventilation’s effects on 275 as therapy 148 overview 186 Gas exchange Enzyme inhibitors, post-transplant protocols 188 carbon dioxide clearance 17–20 immunosuppression 224 route 187 low oxygen partial pressure, causes EPAP. See Expiratory positive airways timing 186–187 12–17 pressure (EPAP) Fell-O’Dwyer apparatus 392–393 oxygen uptake 9–11 Ephedrine 62–63 Fenestrations, in tubes 327 resistance, increased 346–347 Epiglottitis 306 Fentanyl Gas-trapping 340, 338–340, 346, 347 Equipment dead space defined adverse effects 276–280 Gases 143–145 artificial airway management 62–63 density/viscosity 231 Erythromycin 80, 189 overview 179 flow patterns 230–232 Ether 390 properties 179 pressure mechanics 231, 233–235 Etomidate 62–63, 162, 239, 246 Ferryl-haemoglobin 211 Gastric regurgitation, reduction of Expiratory cycling Fick’s Law 120 60–61 described 89, 90–91 FiHe (fractional inspired helium Gastroesophageal reflux 274–275 flow-dependent 90–91, 93 concentration) 230, 232–234 Gentamicin 81, 355 pressure support in 106 Fish oil 190–191 Giertz, K. H. 393–394

416

Index

Gillick competence 308 mode of delivery 232 thoraco-abdominal cuirass 375, Glossopharyngeal breathing (frog overview 230 374–375, 396 breathing) 374–375 respiratory disorder management timeline 399 Glottic injuries 247–248 232 tracheostomy 310, 316, 388 Glucocorticoids 80 respiratory disorders 232 HMV. See Home mechanical Glutamine 190 risks/side effects 234–235 ventilation (HMV) Glyceryl trinitrate, RV failure study data 234 Home mechanical ventilation (HMV) post-transplant 226 tumours and 232 COPD 380–381, 385 Glycopyrrolate 80, 334–336 ventilator issues 232, 233, 231–233, future issues 385 Gram-negative organisms, drugs for 81 234, 235 history, early 376, 374–376, 377 Granulomas 248 Helium 231, 230–231, 232 OHS 381–382 Growth hormone therapy 359–360 Heparin 81 organization 381, 384–385 Guedel’s airways 55, 54–55 HFOV. See High frequency oscillatory patient selection 379–382 Gueugniaud burn treatment 218, 218 ventilation (HFOV) PPV 377–379 Guillain–Barr´e syndrome 27, 353, 355 High-frequency oscillatory ventilation quality of life issues 383–384 (HFOV) therapy targets 384 Haemoglobin airway pressure, increasing 122, Hooke, Robert 388–389 carbon dioxide affinity 146–147, 199 123 Hot water humidifiers 74–75 co-operative binding by 10, 117 ARDS management 127–131, Humane Societies 389 Haemoglobin oxygen saturation in 305–306 Humidification arterial blood carbon dioxide clearance by 127–131 active HMEFs 74 dissociation curve 11, 12, 115, 116 children 305, 305, 306 aerosol drug delivery 80–82 factors affecting 116, 115–116, 117 described 128, 127–128, 129, 131, artificial airway management 74 notation xiii 149–150 HMEFs 74, 75 pulse oximetry measurement of 28, High frequency ventilation (HFV) hot water humidifiers 74–75 27–28, 29 149–150 infants/children 307 Haemophilus influenzae 256–257, 306 High-volume low-pressure (HVLP) cuff mucus water content, increasing 79 Haldane effect 146–147 66, 67, 73, 72–73 overview 74 Haloperidol 170–171 History of ventilation VAP transmission 75, 262 Harvey, William 389 anaesthesia/pneumothorax 392–394 Hunter, John 389 Head injuries, in children 306 anaesthesia/sealed airway 391, HVLP (high-volume low-pressure) cuff Heart 390–391, 392 66, 67, 73, 72–73 left ventricular failure 43, 273, benzodiazepines 310 Hyaline membrane disease 136 339–340 Blease, John 395, 394–395 Hybrid mode right ventricular failure 225–226, Blease Pulmoflator 394–395 described 95–96, 108–112 272, 274 cuffed tubes 391, 390–391, 392 suppression 96 Heat and moisture exchange filters Drinker, Philip 396, 396 synchronization 97 (HMEF) Drinker Respirator 396–397 Hydrocortisone 205 active HMEFs 74 Fell-O’Dwyer apparatus 392–393 Hydroxydione 310 humidification 74, 75 HMV 376, 374–376, 377 Hyoscine butylbromide (buscopan) 80 overview 74 intensive care medicine ix–x Hyper-metabolism, causes 350, random controlled trials 75 iron lungs 373, 372–373, 393, 353–355 in VAP transmission 75, 262 396–397 Hypercapnia Heliox long-term 372–373, 383 aetiology 143 airway obstruction 232 long-term ventilation 372–373, 383 assessment 22–25, 26 application, non-intubated patients negative pressure ventilation bronchodilator therapy 149 232 372–373, 395–397 carbon dioxide narcosis 28 application, ventilated patients 233, NIPPV 377–379 chronic, factors affecting 202 232–233, 234 NIV 377–379 effects of 147, 153–154 application principles 230–232 orotracheal intubation 391, inflammation and 153–154 asthma management 231, 234 390–391, 392 iPEEP and 337–340 carbon dioxide clearance 231 polio epidemics ix, 32, 372–373, management contra-indications 232 398, 395–398, 401 Carbicarb 156 COPD management 231, 234 PPV 373, 389, 388–389, 390, CO2 production, lowering 148 cost issues 231–236 393–394, 401 ECGE in 152–153 density/viscosity 231 prehistory 388–390 HFV in 149–150 FiO2 and 233, 232–233, 234 Scandinavia 1949–1952 397–401 overview 147–148, 149 future prospects 236 Spiropulsator 394, 393–394 permissive 150, 153–154

417

Index

Hypercapnia (cont.) Hysteresis aetiology 9, 7–9 Inspiratory positive airway pressure pulmonary therapies, adjunctive (IPAP) 202–204 149 Ibsen, Bjorn ix, 397–401 Inspiratory time described 88–90 sodium bicarbonate 154–156 Ibuprofen 180 Insufflation anaesthesia 390–392 TGI in 151, 150–151, 152 ICAM-1 activation, hypercapnia and Insulin therapy, intensive 191–192 THAM in 156 153–154 Intensive Care Delirium Screening ventilation, conventional 148–149 ICM (intensive care medicine) ix–x Checklist 167–168 neonates/infants/children 301 IL-8 activation, hypercapnia and Intensive care medicine (ICM) ix–x over-feeding 185 153–154 Intensive care ventilator modes 88–90 oxygen-induced 35–36, 199–200 Imipenem 256–257 Intermittent positive pressure permissive Immune modulating mixes 191 ventilation (IPPV) 289, 314 ARDSnet trials 153, 154, 155 Immuno-suppressed patients 49–50, Intermittent ventilation described 104, barotrauma and 154 253–255 373–374

blast injury treatment 216–217 Immunonutrition Intra-pulmonary shunts in low PO2 14 children 301 arginine 190 Intrinsic fatigue 356–358 contra-indications 150 glutamine 190 Intrinsic positive end-expiratory described 153–154 immune modulating mixes 191 pressure (iPEEP) 39–42, 339, management 150, 153–154 insulin therapy, intensive 191–192 337–339, 340 metabolic alkalosis and 153–154 omega-3 fatty acids 190–191 Inverse-ratio ventilation (IRV) randomized controlled trials 153, overview 189 applications of 122, 123 154, 155 Immunosuppression, lung inspiratory time prolongation by reduction of 145 transplantation 224, 224 125–126 Hypercapnic respiratory failure defined Infants IPAP (inspiratory positive airway 142 airway development, upper 297 pressure) 202–204 Hyperinflation, static/dynamic airway obstruction 298, 306 iPEEP (intrinsic positive end-expiratory 196–198, 206–207 cardiovascular system development pressure) 339, 337–339, 340 Hypertonic saline 79 298 IPPV (intermittent positive pressure Hypertriglyceridaemia 165–166 chest wall development 297–298 ventilation) 289, 314 Hyperventilation therapy, indications control of breathing 299–300 Ipratropium bromide for 333 CPAP/NIV 301–302 asthma/COPD 200 Hypocalcaemia, ionized 147 humidification 307 bronchiolitis 304–305 Hypocapnia lung development in 296–297 mucus production, decreasing 80 effects of 147 lung mechanics in 300–301 Iron lungs 373, 372–373, 393, 396–397 management 147 muscle fatigue in 297–298, 307 IRV. See Inverse-ratio ventilation (IRV) neonates/infants/children 301 nitric oxide therapy 304 Hypotension 202, 206, 205–206, physiology 299, 298–299 Ketamine 239–242 ventilation of 301 asthma/COPD 202 Hypothermia, induced as therapy 148 Infections intubation/airway management 240,

Hypoventilation issues in low PO2 antibiotic-resistant, risk factors 257 246 13–14, 133 control, during transportation Ketorolac 180 Hypovolaemia 130 287–288 Kinetic therapy 260 Hypoxaemia Heliox and 232 Klebsiella pneumoniae, SDD for 260 assessment 22–25, 115–120 nosocomial, propofol-induced barometric pressure in 132 165–166 Labetolol 348–350 COPD 47 respiratory tract isolation 256 Lactic acidosis 200–201 CPAP 42 stomal, tracheostomy 319 Lanz inflation balloon 70, 71 mechanisms/management 120–121 Inflammation Large bowel, ventilation’s effects on 275 nitric oxide as therapy 139 corticosteroids 81 Laryngeal mask airway (LMA) 56, 57 oxygen delivery methods 33–34 hypercapnia and 153–154 Larynx PEEP management of 124–125 lung injury, ventilator-associated functional anatomy 1 perfusion and 16–17 265–267 injuries 243, 248, 247–248 post-operative patients 44 Inspiratory cycling described 89, 90, 92 swelling, assessment of 363, prone position as therapy 139 Inspiratory motive force 362–363, 364 tracheobronchial suctioning 75–76, multiparameter controls 100, 102, visualizing, in infants/children 297 77–78 101–102, 103 Lassen, Henry 397–401 trauma-induced 43 overview 88, 96–99 Lavoisier, Anton 389 West’s zones 18 pressure as drive 93, 94, 98, 101, 102 Left ventricular failure 43, 273, Hypoxia 239–242, 299–300, 337–340 volume as drive 91, 94, 98, 99–101 339–340

418

Index

Length of stay data 332 Lungs indications (See Assessment, of need) Leroy technique 390 artificial 227–228 length of stay data 332 Lignocaine 81 blood flow, poorly ventilated 199 neuromuscular control of 332 Linoleic acid 190–191 collapsed 136 peak inspiratory pressures 264 LIP (lower inflection point) 268, compliance 8, 7–8, 9, 42 Meconium aspiration syndrome 81, 267–268, 269 development 296–297 303–304 Liquid oxygen (LOX) 288 elastance Mecysteine 79–80 Liquid ventilation 228 abdominal distension in 345, 346 Meltzer, S. J. 393 Liver, ventilation’s effects on 275 alveolar recruitment in 346, Metabolic acidosis LMA (laryngeal mask airway) 56, 345–346 acute renal failure 156 57 increased 343 hypercapnia and 155–156 Long, Crawford 390, 390 oedema in 344, 342–344, 345, 346 sodium bicarbonate for 155 Long-term ventilation, history pain relief in 345, 346 weaning and 350, 350, 351 372–373, 383 See also Home pleural disease in 345, 346 Metabolic alkalosis mechanical ventilation posture in 345, 346 permissive hypercapnia and 153–154 (HMV) pulmonary vascular congestion in primary post-ventilation apnoea 336 Lorazepam 344, 342–344, 345, 346 Metaclopramide 189 adverse effects 165 surfactant in 341–346 Metaraminol 62–63 as delirium risk factor 168, 168, 169 elasticity 4–9 Metered dose inhalers (MDIs) 83, 84 vs. haloperidol 170 function, assessment 115–120 Methohexitone 310 primary post-ventilation apnoea functional anatomy Methylprednisolone, post-transplant 336, 334–336 airways 3, 1–3, 4 immunosuppression 224 properties 163 alveoli/blood supply 3, 4 Methylxanthines 360 vs. propofol 164 gas-trapping in 340, 338–340, MicrocuffTM endotracheal tube 259 as sedative, overview 163–164 346, 347 Midazolam LoTrachTM tube 259 mechanics adverse effects 165 Lower, Richard 389 infants/children 300–301 artificial airway management 62–63, Lower inflection point (LIP) 268, pulmonary 5, 4–5, 7, 9 246 267–268, 269 oxygen transfer 10, 9–10, 11 primary post-ventilation apnoea LOX (liquid oxygen) 288 oxygenation of, surface area in 122, 336, 334–336 Lung contusions 219 121–122 properties 163

Lung injury, ventilator-associated perfusion in low PO2 16–17, 18 as sedative, overview 163–164 ARDSnet trials 263–265 recruitable forms 268–269 Minute volume dividers 88–90 children 301 size issues 298–299 Mivacurium 355 lung mechanics role in 267–269, 274 volumes 9, 27 Mixed venous oxygen saturation overview 263–265 Lymphoma 232, 363 calculating 119–120 pathophysiology 267, 265–267 reduction, in hypoxaemia 133, recruitment manoeuvres 268–269 Macrolides 80 134–135 volume vs. pressure 265, 268 Magill, Ivan 391, 391, 392 Modes, of ventilation Lung transplantation Magnesium 355 adaptive support ventilation® 113, airway anastomosis leak/stenosis Magnesium sulphate 201 361 223–224 Management strategy, factors affecting assist pressure control 108, 109 artificial lungs 227–228 361 assist volume control 108, 109 aspiration 224–225 Mandatory breath modes 94, 105, automation of 112–113 challenges 223 104–105 Automode® 113 double vs. single 225 Mannitol 79 back-up system 96 ECMO (See Extracorporeal Matas, Rudolf 392–393 bi-level 111, 109–111, 112 membrane oxygenation Maxillary sinusitis/middle ear effusions breath types and 95, 94–95, 96 (ECMO)) 246–247 expiratory cycling 90–91 immunosuppression 224, 224 Maximal inspiratory pressure hybrid 96, 95–96, 97, 108–112 independent ventilation 225 measurement 27 in hypercapnia management interventional assist devices 227 MDIs (metered dose inhalers) 83, 84 148–149 liquid ventilation 228 Mechanical ventilation inspiratory cycling 90 overview 222–223 adverse effects/complications (See inspiratory motive force (See pleurodesis 224 Adverse effects/complications) Inspiratory motive force) right ventricular failure 225–226 goals of 25 mandatory breath 94, 105, 104–105 spontaneous breathing, Heliox (See Heliox) multiparameter controls 101–103 post-transplant 222–223 history (See History of ventilation) overview 88, 103, 377–379

419

Index

Modes, of ventilation (cont.) acute NMBAs 172–173 CO2 production, reduction of 148 respiratory cycle settings 88–90 AQMS 177 in CO2 production lowering 148 SmartCare® 113–114, 361 CIM 356 depolarizing agents 174 spontaneous breath (See also drug-related 355–358 indications 171, 333 Continuous positive airway thick filament 356 inspiratory time prolongation pressure (CPAP)) Myositis 355–358 125–126 assist control 109 mechanism of action 173–174 bi-level 109–110, 111 Naloxone 180, 334–336 monitoring 171–172 described 90, 95, 105, 107, 108, Narcotics, monitoring 178 non-depolarizing agents 174 377–379 Nasal cannulae 34, 33–34, 35 overview 172–173, 175 SIMV 110 Nasopharyngeal airways primary post-ventilation apnoea tracheostomy 378–379 complications 243–245, 246–247 336, 334–336 triggered breath overview 55, 56 study data 172–173 assist control 109 Nasotracheal intubation Neuromuscular conduction 335, 355 bi-level 109–110, 111 bronchiolitis 300, 304–305 Neuromuscular disorders, NIV therapy described 90, 94–95, 105, 107, complications 315 379–380, 384 106–107, 108, 377–379 in VAP transmission 261 Neuromuscular transmission fatigue hybrid mode 95–96 Nebulizers 356–358 SIMV 110 jet 82 NF-kB activation 153–154, 270 tube resistance, compensation for mucus water content, increasing 79 NIPPV. See Non-invasive positive 114 overview 82 pressure ventilation weaning and 361 polymer cross-linkage reduction Nitric oxide Monoclonal antibodies, 79–80 infants/children/neonates 304 post-transplant ultrasonic 82 RV failure post-transplant 226 immunosuppression 224 vibrating mesh 82 as therapy 139 Montelukast 201 Nedocromil sodium, asthma/COPD Nitrogen, density/viscosity 231 Morphine 201 NIV. See Non-invasive ventilation as delirium risk factor 168–169 Negative pressure ventilation (NIV) overview 178–179 described 97 NMBAs. See Neuromuscular blocking properties 179 history 372–373, 395–397 agents (NMBAs) Morton, William 390 HMV 374–377 Non-invasive positive pressure Motor neuron disease (MND) 377, Neomycin 355 ventilation (NIPPV) 30, 379–380 Neonates 377–379 See also Non-invasive Mouth, ventilation’s effects on 274–275 airway development, upper 297 ventilation (NIV) MPM model, hyperoxia 270 cardiovascular system development Non-invasive ventilation (NIV) MRI transfers, intra-hospital 291–293 298 ARF 43, 49–50 MRSA 81, 256–257, 260 chest wall development 297–298 asthma/COPD 49, 201–202 Mucoactive agents congenital diaphragmatic hernia benefits/limitations 54, 377, 379, mucus production, decreasing 80 302–303, 304 382–384 mucus water content, increasing 79 CPAP/NIV 301–302 cardiogenic pulmonary oedema overview 78–79 HFOV 305–306 42–43 polymer cross-linkage reduction nitric oxide therapy 304 children 301–302 79–80 ventilation of 301, 302 contra-indications 201 Mucus production, decreasing 80 Neostigmine 334–336 COPD and 35–36, 43, 46–47 Muscle contraction 352, 351–352, 353 Neural fatigue 356–358 COPD management via 49, 201–202, Muscle fatigue Neurological disorders 30 380–381, 385 as adverse effect 333 Neurological function, ventilation’s COPD study data 43–44, 45, 45, 46, assessment of 29–30 effects on 276–280 380–381, 385 asthma/COPD and 24–25 Neuromuscular blocking agents delivery, practical aspects 47, 50–51 defined 24–25, 357, 356–357, 358 (NMBAs). See also specific agents history 377–379 in infants/children 297–298, 307 acute necrotizing myopathy 205 NM disease 379–380 Muscle mass 359–360 adverse reactions 171, 176–177, OHS 381–382 Muscle training 359 276–280 OSAHS 43 Myasthenia gravis 27, 355 aminosteroid agents 174, 175–176 overview 32, 44–45, 51 Mycophenolate mofetil, post-transplant AQMS 177 post-extubation 368 immunosuppression 224 asthma/COPD 203 post-transplant 222–223 Myopathy benzylisoquinolinium agents re-intubation and 48–49 acute necrotizing 205, 205, 356 174–175 settings, standard 202

420

Index

study data 44–45 properties 179 mixed venous oxygen saturation, therapy targets 384 Opioids. See also specific agents calculating 119–120 in transportation 289–290 adverse effects 276–280 nitric oxide as therapy 139 weaning 47–48 artificial airway management 62–63 overview 10, 9–10, 11, 115, 116 Non-depolarizing NMBA agents 174 gastroesophageal reflux 274–275 oxygen consumption, calculating 119 See also specific agents primary post-ventilation apnoea oxygen delivery, calculating 119 Nosocomial infection, 336, 334–336 patient assessment 118, 115–119, 120 propofol-induced 165–166 tidal volumes, poor 336–337 prone position as therapy 139 Novalung 152–153, 227 withdrawals 278 recruitment manoeuvres 118–119, NSAIDs Oral hygiene 72 131 adverse reactions 181 Oropharyngeal airways sigh 132 mucus production, decreasing 80 cuff deflation 71 surface area in 122, 121–122 overview 180 defined 54 tracheobronchial suctioning 75–76 Nuffield, William Richard Morris insertion technique 56 V/˙ Q˙ mismatch 133–139 396–397 overview 55, 54–55 Nutritional support securing, of tube 69, 67–69 Paediatric patients. See Children; energy requirements 184–185 Orotracheal intubation Infants; Neonates; Premature enteral (See Enteral nutrition) history 391, 390–391, 392 babies extubation 367 swallowing dysfunction 247 Pain relief in lung elastance 345, 346 feeding, practical aspects 186–189 OSA (obstructive sleep apnoea) 378, Pancuronium 175, 355 hypocaloric feeding 185–186 384 Paracetamol 148, 180 immunonutrition 189–191 OSAHS (obstructive sleep apnoea Paralysis indications 187 hypoventilation syndrome) 42, adverse reactions 176–177 over-feeding 185 43 indications 171 overview 184, 192–193 Outlets, for oxygen 58–59, 61, monitoring 171–172 parenteral (See Parenteral 285–286 overview 171 nutrition) Oxy-haemoglobin Paralytic agents. See Neuromuscular protein requirements 186 in CO2 transport 199 blocking agents (NMBAs) status/outcome 184 dissociation curve 12, 16, 147 Parapac 289 ECGE 152–153 Parenteral nutrition Obesity and hypocaloric feeding Oxygen, density/viscosity 231 vs. enteral 187 185–186 Oxygen consumption, calculating enteral and 187–188 Obesity-hypoventilation syndrome 119 indications 187 (OHS) 381–382 Oxygen cylinders 62, 288, 293 overview 186 Obstructive sleep apnoea Oxygen delivery therapy Partial pressure of carbon dioxide in hypoventilation syndrome calculations 119, 292 alveolar gas (PaCO2) xiii, 9–11, (OSAHS) 42, 43 CPAP vs., study data 42–43 17–20 Obstructive sleep apnoea (OSA) 378, hypercapnia 35–36 Partial pressure of carbon dioxide in 384 interface 34, 33–34, 35, 36 arterial blood (PaCO2) Oedema overview 33, 37 in COPD/NIV monitoring 46–47 cardiogenic/non-cardiogenic 23 PaO2/FiO2 relationship 33 defined 142 children 307 safe use 37, 132–133 factors affecting 17–20, 29–30 in lung elastance 344, 342–344, 345, target saturations 37 inspiratory motive force, 346 Oxygen toxicity 270, 269–270, 271 pressure-driven 101 lung injury, ventilator-associated Oxygenation inspiratory motive force, 265–267 arterial oxygen content, calculating volume-driven 99–101 paralysis and 176–177 119 management 148 Oesophagitis 274–275 artificial airway management 58–59, neonates/infants/children 301 Oesophagus 243, 274–275 60, 61, 62 neurological function and 276–280 OHS (obesity-hypoventilation diffusion coefficient 132 notation xiii syndrome) 381–382 diffusion distance in 121, 133 therapy targets 384 Olanzapine 170–171 ECGE 152–153 Partial pressure of carbon dioxide Omega-3 fatty acids 190–191 HFOV 127–131 (PCO2) xiii, 299–300 One lung ventilation 66–67 HFV management 149–150 Partial pressure of inspired oxygen 132 Opioid agonists. See also specific agents hypoxaemia (See Hypoxaemia) Partial pressure of oxygen xiii adverse reactions 180 inspiratory time prolongation Partial pressure of oxygen in alveolar as delirium risk factor 168–169 125–127 gas (PaO2) xiii, 10, 9–11, 16, overview 178–180 low arterial pressure, causes 12–17 132

421

Index

Partial pressure of oxygen in arterial Phrenic nerve damage, breathing in hypoxaemia management blood (PaO2) capacity and 353–355 124–125 aeromedical transportation Physiological dead space 143–145 infants/children 300–301 calculations 294–295 Physiological notation neurological function and 276–280 calculation of 118–119 key xiii physiological 124 changes, surgical overview xiii, xiii, xiv recruitment manoeuvres 131 patients/PPV/anaesthesia 263 Physiotherapy 149 right ventricular failure 225–226 factors affecting 9–11, 142 Piperacillin/tazobactam 256–257 TGI and 151, 150–151, 152 FiO2 relationship 33 Pleural disease in lung elastance 345, tidal volumes, poor 336–337 HFOV settings 127–131 346 tracheobronchial suctioning 75–76, limitations 118–119 Pneumomediastinum 250–253 77–78 low partial pressure, causes 12–17 Pneumonia in transportation 289–290 neonates/infants/children 301 aspiration 242–243 Positive pressure ventilation (PPV) notation xiii assessment 23–24 history 373, 389, 388–389, 390, optimization issues 47 children 303–304 393–394, 401 oxygen toxicity and 270, 271 CPAP 43–44 HMV 374–377 Parvolex® 79–80 gastric residual volumes and 188–189 mechanism of action 9, 7–9

Pathological shunts in low PO2 14 ventilator-associated (See PaO2 changes, surgery/anaesthesia Patient–ventilator asynchrony 100 Ventilator-associated patients 263 Patient–ventilator dys-synchrony pneumonia (VAP)) physiological effects 275 (PVD) 339, 337–339, 340 Pneumonitis, aspiration 242–243, right ventricular performance effects PAV (proportional assist ventilation) 245 272, 274 106–108 Pneumopericardium 250–253 venous return effects 271–272, 273 PCP pneumonia, drugs for 81 Pneumothorax Post-surgical patients 44, 164–165 PEEP. See Positive end-expiratory as adverse reaction 241–242 Posture in lung elastance 345, 346 pressure (PEEP) anaesthesia and, in history 392–394 PPHN (pulmonary hypertension of the Pendelluft aetiology 9, 7–9 asthma/COPD 202, 206–207 newborn) 298, 303–304 Pentamidine 81 barotrauma 250–253 PPV. See Positive pressure ventilation Perfluorocarbons (PFCs), in liquid blast injuries 213–214 (PPV) ventilation 228 chest drain, insertion technique 254 Pranlukast 201

Perfusion in low PO2 16–17, 18 tension 252, 253 Pregabalin 348–350 Periodic breathing 299, 299, 300, 340 tracheostomy-associated 318 Premature babies 301–302 Permissive hypercapnia. See also trauma-induced 43 Pressure Hypercapnia in underdeveloped lungs 296–297 airway, increasing 122, 123 ARDSnet trials 153, 154, 155 Pneupac series ventilators 289 gases, mechanics 231, 233–235 barotrauma and 154 Poiseuille’s law 299 lung injury, ventilator-associated blast injury treatment 216–217 Polio epidemics ix, 32, 372–373, 398, 263–265 children 301 395–398, 401 lungs, mechanics 5, 4–5, 9–11 contra-indications 150 Polyethylene glycol toxicity 165 Pressure conversion factors xiv described 153–154 Polymer cross-linkage reduction 79–80 Pressure support ventilation (PSV) management 150, 153–154 Polyurethane cuffs/tubes 324 336–337 metabolic alkalosis and 153–154 Positive end-expiratory pressure Primary post-ventilation apnoea 336, random controlled trials 153, 154, (PEEP). See also Continuous 334–336 155 positive airway pressure (CPAP) Procainamide 355 Pethidine 168–169, 179 Aa difference calculation 118 Prone position as therapy 139, 300–301 PF ratio 116, 118–119, 270 airway pressure measurement 38 Propanidid 310 pH applications of 124, 125 Propofol alveolar minute volume increase bi-level mode 109–110, 111 adverse effects 165–166, 276–280 relative to 350, 350, 351 bronchiolitis 304–305 artificial airway management 62–63 inspiratory motive force, carbon dioxide clearance and asthma/COPD 202 pressure-driven 101 145–146 expenditures 279 inspiratory motive force, complications/contraindications overview 164 volume-driven 99–101 125, 126, 198 properties 163 permissive hypercapnia 153–154 COPD 204–205 Proportional assist ventilation (PAV) Pharyngo-laryngeal dysfunction 247 CPAP, physiological effects 41, 106–108 Pharynx, functional anatomy 1–4 39–41, 42 Propylene glycol toxicity 165 Phipps Respiratory Unit 375–376 future research directions 269 ProSealTM LMA 56 Phosphatidylcholine 6, 4–6, 9 history 32 Prostacyclin 81

422

Index

Pseudomonas aeruginosa, SDD for 260 Reports, semi-quantitative vs. Saturation of arterial haemoglobin with PSV (pressure support ventilation) quantitative 256 oxygen (SaO2) 115, 118–119 336–337 Respiration, periodic 299, 299, 300, Sauerbruch, Ferdinand 393 Psychological morbidity, ventilation’s 340 SBT (spontaneous breathing trial) 361, effects on 276–280 Respiratory acidosis 360–361 Pulmonary hypertension of the hypercapnia and 153–154 Schreiter on recruitment manoeuvres newborn (PPHN) 298, 303–304 sodium bicarbonate for 155, 156 219 Pulmonary mechanics overview 5, 4–5, Respiratory alternans 27 SDD (selective decontamination of the 7, 9 Respiratory cycle digestive tract) 260 Pulmonary vascular congestion in lung described 89, 88–89, 90 Secretion clearance 366, 364–366, 367 elastance 344, 342–344, 345, suppression, adverse effects of 333 Sedation 346 (See also Muscle fatigue) adverse effects 165–166, 245, Pulmonetic LTV1000 290, 291 suppression, indications for 333 276–280 Pulse oximetry Respiratory disorders, Heliox in CO2 production lowering 148 in airway management 59 management 232 as delirium risk factor 168–169 need assessment via 28, 27–28, 29 Respiratory quotient 148, 348 management 166–167 Pulsus paradoxus 199 Respiratory rate 88 medications overview 163, 162–163 PVD (patient-ventilator dys-synchrony) Respiratory rate/tidal volume 145, 341, (See also specific medications) 339, 337–339, 340 347–351 monitoring 161–162 Respiratory syncytial virus (RSV) 81, overview 161, 333 Quality/length of life principle 22 304–305 primary post-ventilation apnoea Quality of life issues 383–384 Respiratory system compliance 8, 7–8, 336, 334–336 Quetiapine 170–171 9 tidal volumes, poor 336–337 Quinine 355 Respiratory tamponade 198 Selective decontamination of the Responauts 375–376 digestive tract (SDD) 260 Rabbit-derived anti-thymocyte Reversibility principle 21–22 SensorMedics 3100B 128, 129, 130 globulin (R-ATG) 224 Reynolds number (RN) 230–232, Sepsis Radiological maxillary sinusitis (RMS) 346–347 assessment 26, 119–120 261 Rhabdomyolysis 355–358 children 307 Ramsay scale 161 rhDNase 79–80, 81 and CO2 production 144, 148 Rapid shallow breathing index (RSBI) Ribavirin 81 CPAP, study data 44 366 Richmond Agitation Sedation Scale critical illness myopathy 356 RASS (Richmond Agitation Sedation (RASS) 162, 161–162, 336 as delirium risk factor 168 Scale) 162, 161–162, 336 Right ventricular failure 225–226, 272, ECMO 226–227 Rate/tidal volume measurement 26–27 274 fish oil 190–191 RCT. See Randomized controlled trials Risperidone 170–171 insulin therapy, intensive 191–192 (RCTs) RMS (radiological maxillary sinusitis) laryngeal injuries 247–248 Recruitment manoeuvres (RMs) 261 nasal intubation 65 as ARDS/ALI therapy 118–119, 131 Rocking beds 374–375 paralytic agents and 173 described 131 Rocuronium Severe pulmonary hypertension 150 as diffuse alveolar haemorrhage neuromuscular conduction Shaw, Louis 396, 396 therapy 139 dysfunction 355 Shock 33–34 future research directions 269 overview 176 Shunting 133–139, 152–153

ventilator-associated lung injury properties 175 Shunts in low PO2 268–269 Rowbotham, Stanley 391, 391, 392 alveolar/true 14–15 Reflectance coefficient 344, 342–344, RRT (renal replacement therapy) 350, anatomical 14 345 350, 351 pathological 14 Remifentanil RSBI (rapid shallow breathing index) total, estimation of 12, 16 adverse effects 276–280 366 Sigh described 132 expenditures 279 RSV (respiratory syncytial virus) 81, Silicone cuffs/tubes 324–325 overview 179–180 304–305 Silver cuffs/tubes 325 primary post-ventilation apnoea SIMV. See Synchronized intermittent 336, 334–336 Salbutamol mandatory ventilation (SIMV) properties 179 as asthma/COPD therapy 199–200 Sleep, ventilation’s effects on 276, 277, Renal function, ventilation’s effects on bronchiolitis 304–305 278, 279, 349, 348–349, 350, 275–276 lactic acidosis 200–201 384 Renal replacement therapy (RRT) 350, SAPS II model, hyperoxia 270 Small intestine, ventilation’s effects on 350, 351 SARS 50, 81 274–275

423

Index

SmartCare® 113–114, 361 in alveoli 6, 4–6, 9 oxygenation 75–76 Smith, J. Lorrain 269 ARDS/meconium aspiration Tracheostomy Sockets, for oxygen 58–59, 61, 285–286 management 81 in airway securement 57–58 Sodium bicarbonate 154–156 development of 296–297 benefits/limitations 377, 382–384 Sodium cromoglycate, asthma/COPD dysfunction 267, 265–267 complications 201 hyaline membrane disease 136 airway obstruction 78, 311, 312, Sodium nitroprusside, RV failure in lung elastance 341–346 319 post-transplant 226 Suxamethonium 240, 240, 241, 246, de-cannulation 318–319 Sorkine study, blast injuries/PIP 355 early/late 317, 318–321 216–217 Swallowing dysfunction 247, 247, overview 315, 311–315, 316, 317 Speaking valves/caps 327 320–321 perioperative 317, 316–317, 318 Spencer, Geoffrey 375–376 Sylvester technique 390 stomal infection 319 Spinal fatigue 356–358 Synchronized intermittent mandatory swallowing dysfunction 320–321 Spiropulsator 394, 393–394 ventilation (SIMV) tracheo-innominate artery fistula Spontaneous awakening study 166–167 asthma/COPD 204–205 319–320 Spontaneous breath mode described 108–109, 110 defined 54 assist control 109 in transportation 289–290 equipment, bedside 328 bi-level 109–110, 111 triggered breaths in 95 glottic injuries 247–248 described 90, 95, 105, 107, 108, history of 310, 316, 388 377–379 (See alsoContinuous T-cell inhibitors, post-transplant home-use 383 positive airway pressure (CPAP)) immunosuppression 224 indications 311, 313 SIMV 110 Tacroe cuff pressure controller 70–71 mini/cricothyroidotomy 327–328 Spontaneous breathing, Tacrolimus, post-transplant risk/benefit ratio 314, 311–314, 316 post-transplant 222–223 immunosuppression 224 techniques Spontaneous breathing trial (SBT) 361, Tension-time index 359 overview 321 360–361 TGI (tracheal gas insufflation) 151, percutaneous 311, 321, 323, Staphylococcus aureus 256–257 150–151, 152 322–323, 324 Starling equation 344, 342–344, 345 THAM (tromethamine) 156 single dilator 324 Static compliance 8, 7–8, 9 Thick filament myopathy 356 surgical 322, 321–322 Static hyperinflation 196–198 Thiopentone 239 timing 311–316, 360–361 Steroids, intravenous 200 Thoraco-abdominal cuirass 375, tube resistance, compensation for Steroids, parenteral 205 374–375, 396 114 Stomach, ventilation’s effects on Thoraco-abdominal motion tubes, choosing 318, 325, 324–325, 274–275 measurement 27 326, 327 Streptococcus pneumoniae 256–257 Tidal volume/frequency in CO2 VAP transmission via aspiration Stridor, post-exubation 363, 362–363, clearance 145 258–261 364 Tilting bed/trolley 61 ventilation modes 378–379 Stroke and oxygen toxicity 270, 271 TLC (total lung capacity) 9 Train-of-four (TOF) testing 172, 335 Sub-glottic secretion drainage 71–72 Tobramycin 81 Tranexamic acid 137 Succinylcholine 174 TOF (train-of-four) testing 172, 335 Trans-laryngeal intubation 314, Suction apparatus 61–62 Tossach, William 389 311–314, 315, 316 Sufentanil 276–280 Total lung capacity (TLC) 9 Transmural pressure 7, 272 Supply capacity determinants Trachea Transplantation, of lungs. See Lung CNS 351–352 functional anatomy 1–3 transplantation muscle contraction in 352, 351–352, injuries 243, 248–249, 318 Transportation issues 353 stenosis 249, 249, 320 aeromedical 290, 294, 293–294, 295 muscle function, improving 358–360 Tracheal gas insufflation (TGI) 151, equipment/procedures 286, 285–286 Supraglottic airways 150–151, 152 hazards/risks 285, 284–285, 287 Combitube 56 Tracheal intubation 54, 286–287 indications/contra-indications 284, defined 54 Tracheal stenosis 249, 249, 320 285 LMA 56 Tracheo-innominate artery fistula infection control 287–288 nasopharyngeal 55 319–320 intra-hospital/MRI transfers 291–293 oropharyngeal 55, 54–55 Tracheobronchial suctioning manual ventilation 290–291 SupremeTM LMA 56 airway obstruction 78 monitoring 286, 285–286 Surface area, in oxygenation 122, catheter issues 76–77 need assessment 285 121–122 indications 75 oxygen supplies 288, 292 Surface tension, in alveoli 5, 4–5, 9 open vs. closed 77–78 patient preparation 286–287 Surfactant overview 75 tracheostomy 316

424

Index

transport ventilators 289, 288–289, Ventilation requirements, calculation of gas-trapping 340, 338–340, 346, 347 290 (See also specific types by 17–20 initiation, timing of 331–332 name) Ventilator-associated lung injury. See lung elastance, pulmonary vascular Trauma Lung injury, congestion in 344, 342–344, barotrauma (See Barotrauma) ventilator-associated 345, 346 cervical spine damage 243–245 Ventilator-associated pneumonia (VAP) metabolic acidosis 350, 350, 351 chest (See Chest trauma) aetiologies 71–73, 75, 83–85, metabolic alkalosis 336 complications 43 253–255 muscle training 359 CPAP 42, 43 diagnosis 256, 255–256 NIV 47–48 endotracheal intubation 43 prevention 72, 75, 258, 257–258 patient–ventilator dys-synchrony oxygenation via tracheobronchial risk factors/outcome 255, 257, 259, 339, 337–339, 340 suctioning 75–76 262–263 protocols 361–362 Triggered breath mode transmission second stage 341, 360–361 assist control 109 via aspiration 257, 258–261 speaking valves/caps 327 bi-level 109–110, 111 breathing circuit 72, 262 tidal volumes, poor 336–337, 348 described 90, 94–95, 105, 107, horizontal 261–263 time requirements 331 106–107, 108, 377–379 humidification 75, 262 ventilation, neuromuscular control in hybrid mode 95–96 sub-glottic secretion drainage 72, of 332 SIMV 110 71–72, 262 work of breathing determinants (See Tromethamine (THAM) 156 treatment 256–257 Work of breathing

True shunts in low PO2 14–15 Ventilator-induced diaphragmatic determinants) Tube cutting technique 66 damage (VIDD) West’s zones 16–17, 18, 145, 146 Tumors, Heliox and 232 overview 269, 332, 356 White card test 366 Type 1 respiratory failure defined 142 oxygen, safe levels of 270–271 Work of breathing determinants Type 2 respiratory failure defined 142 oxygen toxicity 269–270 dead space 351 Ventipac 289 delirium (See Delirium) Uni-Vent Eagle TM754 290, 291 Venturi principle 34, 36 diaphragmatic contractility 339, 360 Unit conventions xiv, xiv Vesalius, Andreas 388, 389 elastance, increased 343, 346 VIDD. See Ventilator-induced emotional factors 349 Van den Berghe study, insulin therapy diaphragmatic damage (VIDD) FRC/CPAP effects on 39–42 191–192 Villar study, PEEP 216 inertia/friction 347, 333–347 Vancomycin 81, 256–257 Volume-targeted constant flow metabolic acidosis 350, 350, 351 VAP. See Ventilator-associated mechanical ventilation overview 342 pneumonia (VAP) pressure/time profile 9 pneumonia 23–24 Vasodilators, RV failure post-transplant Volume-targeted pressure control resistance, increased 346–347 226 (VPC) ventilation 104–105, respiratory rate/tidal volume 145, Vecuronium 106 341, 347–351 AQMS 177 Volumetric CT scanning trial, PEEP 125 supply capacity neuromuscular conduction VPC (volume-targeted pressure control) CNS 351–352 dysfunction 355 ventilation 104–105, 106 muscle contraction in 352, overview 175–176 351–352, 353 properties 175 Waters system 291, 290–291, 398 muscle function, improving Venous blood, gas exchange 9–11 Weaning 358–360

Ventilation inequality in low PO2 apnoea muscle function disorders 15–16, 17 primary post-ventilation 336, 355–358 Ventilation/perfusion (V/˙ Q)˙ mismatch 334–336 neuromuscular conduction 335, focal alveolar ventilation causes secondary 340, 339–340 355 136 de-cannulation (SeeDe-cannulation) peripheral neuropathies 350, 354, infants/children 300–301 dead space 351 353–354, 355 in oxygenation 136, 133–136, 139 defined 331 prone position as therapy 139 extubation (See Extubation) Zafirlukast 201 in underdeveloped lungs 296–297 first stage 332–340 Ziprasidone 170–171

425