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Principles of Mechanical Ventilation

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Principles of Mechanical Ventilation CHAPTER © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 3NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC PrinciplesNOT FOR SALE OR DISTRIBUTION of MechanicalNOT FOR SALE OR DISTRIBUTION Ventilation © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTGregory FOR SALE A. OR Holt, DISTRIBUTION Sheila A Habib, andNOT David FOR SALE C. Shelledy OR DISTRIBUTION © Thep © Thep Urai/Shutterstock © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION OUTLINE Complications of Mechanical Ventilation Pulmonary Introduction to Mechanical© Ventilation Jones & Bartlett Learning, LLCExtrapulmonary Organ Systems © Jones & Bartlett Learning, LLC Ventilation NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Spontaneous Breathing Negative Pressure Breathing OBJECTIVES Positive Pressure Breathing 1. Summarize the history of events that led to modern Invasive Versus Noninvasive Ventilation mechanical ventilation. Ventilator Principles © Jones & Bartlett Learning, LLC 2. Contrast© the Jones differences & betweenBartlett positive Learning, and negative LLC Input Power and Control Systems pressure ventilation. VentilatorNOT Variables:FOR SALE Breath Trigger OR DISTRIBUTION 3. RecognizeNOT differences FOR inSALE patient interface OR DISTRIBUTION when considering Ventilator Variables: Breath Cycle invasive and noninvasive mechanical ventilation. Operator Interface 4. Define the timing points that constitute a breath and Ventilator Classification or Taxonomy calculate the respiratory rate from TI and TE. Ventilator Modes 5. Describe alveolar and dead space ventilation and calculate Continuous Mandatory Ventilation V˙ E and V˙ A. © Jones & BartlettIntermittent MandatoryLearning, Ventilation LLC © Jones6. Interpret& Bartlett changes Learning, in volume, airflow, LLC and alveolar and NOT FOR SALEPositive OREnd-Expiratory DISTRIBUTION Pressure NOT FORintrapleural SALE pressure OR DISTRIBUTION over the course of a single breath. Continuous Positive Airway Pressure 7. Describe the differences between an iron lung and a chest Pressure Support Ventilation cuirass. Airway Pressure Release Ventilation 8. Identify the components of a ventilator circuit and the Automatic Tube Compensation mechanical events during lung inflation and deflation during Proportional Assist Ventilation delivery of a positive pressure breath. Dual Modes and Adaptive© Control Jones & Bartlett Learning, LLC9. Describe the effects of alterations© Jones in lung mechanics& Bartlett Learning, LLC High-Frequency Ventilation NOT FOR SALE OR DISTRIBUTION(CST and RAW) on volume andNOT pressure FOR in volume SALE and OR DISTRIBUTION Neurally Adjusted Ventilatory Assist pressure-control modes. Ventilator Parameters 10. Predict changes in peak inspiratory pressure and plateau Flow Waveforms pressure when either CST or RAW are altered. Inspiratory Pause 11. Define PEEP and describe its influence on gas exchange and FIO2 hemodynamics. PEEP/CPAP© Jones & Bartlett Learning, LLC 12. Describe© theJones variables & of Bartlett interest in an Learning, optimal PEEP study. LLC Alarms 13. Define pressure support ventilation (PSV) and describe its HumidificationNOT FOR SALE OR DISTRIBUTION influenceNOT on the FOR work ofSALE breathing OR (WOB). DISTRIBUTION Sigh Breaths 14. Define CPAP, BiPAP, AutoPAP, ASV, CFLEX, EPR, IPAP, Effects of Mechanical Ventilation on Organ Systems and EPAP. Pulmonary System 15. Describe patient scenarios that will lead to increased mean Cardiovascular System airway and peak inspiratory pressures. Renal System © Jones & Bartlett Learning, LLC © Jones16. Describe& Bartlett the variables Learning, that can be LLC trigger inspiration during Gastrointestinal System mechanical ventilation. NOT FOR SALECentral NervousOR DISTRIBUTION System NOT FOR SALE OR DISTRIBUTION 95 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781284139860_CH03_095_154.indd 95 22/02/19 12:03 PM 96 CHAPTER 3 Principles of Mechanical Ventilation 17. Describe the variables that can cycle a breath from breath cycle oxygen saturation in mixed – © Jones & Bartlettinspiration Learning, to expiration. LLC © Jonesbreath &trigger Bartlett Learning,venous LLC blood (SVO2) NOT FOR SALE18. Contrast OR DISTRIBUTIONthe differences between PC-AC and VC-AC. NOTcontinuous FOR SALE positive OR airway DISTRIBUTION partial pressure of alveolar 19. Contrast the differences between PC-IMV and VC-IMV. pressure (CPAP) oxygen (PaO2) 20. Describe the rationale for prone positioning ARDS patients. dead space volume (VD) partial pressure of arterial 21. Describe lung protective strategies for mechanical ventilation. expiratory positive airway oxygen (PaO2) 22. Define APRV and compare this mode to BiPAP. pressure (EPAP) partial pressure of mixed – 23. Describe the use of automatic tube compensation (ATC). expiratory time (TE) venous oxygen (PVO2) 24. Define PAV and describe© Jones its use. & Bartlett Learning, LLCextrinsic PEEP ©peak Jones airway & pressure Bartlett (PAW Learning,) LLC 25. Identify dual modesNOT of ventilation. FOR SALE OR DISTRIBUTIONflow cycle NOTpeak inspiratoryFOR SALE OR DISTRIBUTION 26. Define PRVC and VAPS. flow-time scalar pressure (PIP) 27. Describe each of the four types of high-frequency ventilation fraction of inspired plateau pressure (Pplateau) (HFV). oxygen (FIO2) positive end-expiratory 28. Contrast the trigger variable used in NAVA to conventional high-frequency jet pressure (PEEP) mechanical ventilation. ventilation (HFJV) positive pressure ventilation 29.© DescribeJones inspiratory & Bartlett flow waveforms Learning, used in LLC mechanical high-frequency© Jonesoscillatory & Bartlettpreload Learning, LLC NOTventilation. FOR SALE OR DISTRIBUTION ventilationNOT (HFOV) FOR SALEpressure OR DISTRIBUTIONcontrol (PC) 30. Determine the ventilator variables that affect PaO2, pH, high-frequency percussive pressure-regulated volume and PaCO2. ventilation (HFPV) control (PRVC) 31. Identify the alarms that require clinician adjustment and the high-frequency pressure support levels of priority assigned. positive pressure ventilation (PSV) 32. Describe the rationale for a sigh breath. ventilation (HFPPV) pressure–time scalar © Jones & 33.Bartlett Explain Learning, the effects of positive LLC pressure ventilation © Joneshyperventilation & Bartlett Learning,proportional LLC assist on the lung. hypoventilation ventilation (PAV) NOT FOR SALE34. Explain OR the DISTRIBUTION effects of positive pressure ventilation on the NOTinspiratory FOR SALE positive OR airway DISTRIBUTION pulmonary vascular cardiac/cardiovascular system. pressure (IPAP) resistance (PVR) 35. Describe the central nervous system (CNS), renal, and inspiratory time (TI) synchronized intermittent gastrointestinal effects of positive pressure ventilation. inspiratory to expiratory mandatory 36. Explain the importance of appropriate sedation protocols ratio (I:E) ventilation (SIMV) during weaning from© mechanicalJones & ventilation. Bartlett Learning, LLCintracranial pressure (ICP) ©tidal Jones volume & (V BartlettT) Learning, LLC 37. Describe the influence of PaCO2 on intracranial intrinsic PEEP time cycling pressure (ICP). NOT FOR SALE OR DISTRIBUTIONiron lung NOTtotal cycleFOR time SALE (Ttot) OR DISTRIBUTION 38. Identify the effects of sleep disruption on the ICU patient. lung compliance (CL) transmural wall pressure 39. List the complications of mechanical ventilation and mean airway pressure ventilator-associated explain each. (MAP) lung injury (VALI) minute alveolar volume ventilator-associated ˙ KEY TERMS minute ventilation (VE) pneumonia (VAP) © Jones & Bartlett Learning, LLC negative pressure© Jones & Bartlettventilator-induced Learning, LLC acidosisNOT FOR SALE OR DISTRIBUTIONatelectotrauma ventilationNOT FOR SALE lungOR injury DISTRIBUTION (VILI) acute lung injury (ALI) atrial natriuretic neurally adjusted ventilator mode acute respiratory distress peptide (ANP) ventilatory assist (NAVA) volume-assured pressure syndrome (ARDS) automatic positive noninvasive positive support (VAPS) afterload airway pressure pressure ventilation volume control (VC) airway pressure release (autoPAP) (NPPV) volume of carbon dioxide ˙ © Jones & Bartlettventilation Learning, (APRV) LLCautomatic servo © Jonesoxygen & content Bartlett in Learning,production LLC (VCO2) airway resistance (RAW) ventilation (autoSV) arterial blood (CaO2) volume of oxygen NOT FOR SALEalkalosis OR DISTRIBUTIONautomatic tube NOToxygen FOR contentSALE in OR mixed DISTRIBUTION uptake (V˙O ) – 2 alveolar volume compensation (ATC) venous blood (CVO2) volume support (VS) amyotrophic lateral autoPEEP oxygen delivery (D˙ O2) volutrauma sclerosis (ALS) bilevel positive airway oxygen saturation in work of breathing (WOB) assist control (A/C) pressure (BiPAP) arterial blood (SaO2) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Introduction to Mechanical was offered by John Emerson in 1932. In the 1940s and Ventilation 1950s, polio epidemics were sweeping across Europe © Jones & Bartlett Learning, LLC and the United© Jones States. Worldwide,& Bartlett 500,000 Learning, people perLLC The development of respiratory care progressed year were either paralyzed or had died from the dis- throughNOT history FOR fromSALE Galen’s OR observationsDISTRIBUTION on the re- ease.1 TheseNOT negative FOR pressure SALE ventilators OR DISTRIBUTION were
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