Clinical Application of Mechanical Ventilation / Edition 1

Clinical Application of Mechanical Ventilation / Edition 1

by David W. Chang

ISBN-10: 0827373201

ISBN-13: 9780827373204

Pub. Date: 02/28/1997

Publisher: Cengage Learning

Respiratory therapy and nursing students will find this a concise, easy-to-read book that will help them learn the basic concepts and clinical techniques related to mechanical ventilation. The information is current and presented logically for easier understanding. Three new chapters cover important new information on temporary airways used for ventilation in


Respiratory therapy and nursing students will find this a concise, easy-to-read book that will help them learn the basic concepts and clinical techniques related to mechanical ventilation. The information is current and presented logically for easier understanding. Three new chapters cover important new information on temporary airways used for ventilation in non-traditional settings, ventilator waveforms that appear in computer graphics, and non-invasive positive pressure ventilation often used in home care settings.
Key features:
New chapter on Ventilator Waveform Analysis teaches students to understand the interaction of mechanical ventilation between the patient and equipment. Numerous examples of waveforms provide extensive coverage of various clinical conditions.
Fifteen case studies help promote understanding of the different uses of mechanical ventilation, and allow the reader to apply concepts learned to real-life scenarios.
Key points highlighted in the margin allow the reader to focus on essential concepts
NBRC-type questions enhance the development of critical thinking
(KEYWORDS: respiratory care, respiratory therapists, respiratory therapy, nursing, mechanical ventilation)

Product Details

Cengage Learning
Publication date:
Respiratory Care Ser.
Edition description:
Older Edition
Product dimensions:
7.87(w) x 9.45(h) x (d)

Table of Contents

Chapter 1Principles of Mechanical Ventilation1
Airway Resistance3
Lung Compliance5
Deadspace Ventilation9
Ventilatory Failure11
Oxygenation Failure15
Clinical Conditions Leading to Mechanical Ventilation17
Chapter 2Effects of Positive Pressure Ventilation25
Pulmonary Considerations26
Cardiovascular Considerations29
Hemodynamic Considerations33
Renal Considerations34
Hepatic Considerations37
Abdominal Considerations38
Nutritional Considerations38
Neurological Considerations41
Chapter 3Classification of Mechanical Ventilators49
Ventilator Classification50
Ventilatory Work51
Input Power52
Drive Mechanism52
Control Circuit55
Control Variables57
Phase Variables59
Output Waveforms64
Alarm Systems70
Chapter 4Operating Modes of Mechanical Ventilation75
Negative and Positive Pressure Ventilation77
Operating Modes of Mechanical Ventilation79
Positive End-Expiratory Pressure (PEEP)80
Continuance Positive Airway Pressure (CPAP)84
Bi-level Positive Airway Pressure (BIPAP)84
Controlled Mandatory Ventilation (CMV)86
Assist Control (AC)88
Intermittent Mandatory Ventilation (IMV)90
Synchronized Intermittent Mandatory Ventilation (SIMV)91
Mandatory Minute Ventilation (MMV)94
Pressure Support Ventilation (PSV)96
Pressure Control Ventilation (PCV)99
Proportional Assist Ventilation100
Airway Pressure Release Ventilation (APRV)101
Inverse Ratio Ventilation (IRV)103
Chapter 5Temporary Airways for Ventilation112
Esophageal Obturator Airway (EOA)113
Esophageal Gastric Tube Airway (EGTA)115
Laryngeal Mask Airway (LMA)116
Pharyngealtracheal Lumen Airway (PTLA)122
Chapter 6Airway Management in Mechanical Ventilation129
Common Artificial Airways in Mechanical Ventilation132
Intubation Procedure134
Management of Endotracheal and Tracheostomy Tubes145
Complications of Endotracheal Intubation153
Chapter 7Noninvasive Positive Pressure Ventilation161
Use of Continuous Positive Airway Pressure (CPAP)164
Use of Bilevel Positive Airway Pressure (Bilevel PAP)166
Common Interfaces for CPAP and Bilevel PAP168
Potential Problems with Interfaces172
Titration of Continuous Positive Airway Pressure173
Titration of Bilevel Positive Airway Pressure173
Chapter 8Initiation of Mechanical Ventilation179
Initial Ventilator Settings185
Ventilator Alarm Settings193
Hazards and Complications195
Chapter 9Monitoring in Mechanical Ventilation204
Vital Signs205
Chest Inspection and Auscultation209
Fluid Balance and Anion Gap212
Arterial Blood Gases214
Oxygen Saturation Monitoring218
End-Tidal Carbon Dioxide Monitoring223
Transcutaneous Blood Gas Monitoring229
Chapter 10Hemodynamic Waveform Analysis238
Hemodynamic Monitoring239
Arterial Catheter241
Central Venous Catheter245
Pulmonary Artery Catheter247
Summary of Preloads and Afterloads255
Calculated Hemodynamic Values256
Monitoring of Mixed Venous Oxygen Saturation257
Chapter 11Basic Ventilator Waveform Analysis264
Flow Waves Used for Positive Pressure Ventilation266
Effects of Constant Flow during Volume-controlled Ventilation268
Spontaneous Ventilation during Mechanical Ventilation277
Effects of Flow, Circuit, and Lung Characteristics on Pressure-time Waveforms280
Effects of Decelerating Flow during Volume-Controlled Ventilation282
Waveforms Developed during Pressure-limited Ventilation290
Pressure Support and Spontaneous Modes of Ventilation294
Effects of Lung Characteristics on Pressure-limited Waveforms297
Using Waveforms for Patient and Ventilator-system Assessment298
Using the Expiratory Flow and Pressure Waves as Diagnostic Tools306
Troubleshooting Ventilator Function312
Pressure-volume and Flow-volume Curves or Loops313
Chapter 12Management of Mechanical Ventilation325
Strategies to Improve Ventilation326
Strategies to Improve Oxygenation330
Acid-base Balance335
Troubleshooting of Common Ventilator Alarms and Events337
Care of the Ventilator Circuit342
Care of the Artificial Airway345
Fluid Balance349
Electrolyte Balance350
Chapter 13Pharmacotherapy for Mechanical Ventilation363
Drugs for Improving Ventilation364
Delivery of MDI Medications372
Neuromuscular Blocking Agents373
Sedatives and Antianxiety Agents (Benzodiazepines)382
Narcotic Analgesics385
Agents for Seizures and Elevated Intracranial Pressure (Barbiturates)390
Other Agents Used in Mechanical Ventilation392
Chapter 14Weaning From Mechanical Ventilation403
Definition of Weaning Success and Failure404
Patient Condition Prior to Weaning406
Weaning Criteria406
Combined Weaning Indices413
Weaning Procedure415
Signs of Weaning Failure417
Causes of Weaning Failure417
Terminal Weaning420
Chapter 15Neonatal Mechanical Ventilation428
Surfactant Replacement Therapy431
Basic Principles of Neonatal Ventilation433
Initiation of Neonatal Ventilator Support437
High Frequency Ventilation (HFV)440
Other Methods of Ventilation445
Extracorporeal Membrane Oxygenation (ECMO)446
Chapter 16Home Mechanical Ventilation459
Goals of Home Mechanical Ventilation460
Patient Selection464
Equipment Selection466
Learning Objectives for Positive Pressure Ventilation in the Home469
Chapter 17Case Studies506
Case 1COPD507
Case 2Status Asthmaticus512
Case 3Postabdominal Surgery517
Case 4Head Injury520
Case 5Smoke Inhalation524
Case 6Drug Overdose528
Case 7Tension Hemopneumothorax532
Case 8Chest Trauma537
Case 9Adult Respiratory Distress Syndrome543
Case 10Myasthenia Gravis549
Case 11Guillain-Barre555
Case 12Botulism562
Case 13Meconium Aspiration/Patent Ductus Arteriosus566
Case 14Persistent Pulmonary Hypertension of the Newborn570
Case 15Home Care and Disease Management573
Appendix 1Respiratory Care Calculations581
AAirway Resistance: Estimated (R[subscript aw])582
BAlveolar-Arterial Oxygen Tension Gradient: P(A - a)O[subscript 2]582
CAnion Gap584
DCompliance: Dynamic (C[subscript dyn])584
ECompliance: Static (C[subscript st])585
FCorrected Tidal Volume (V[subscript T])585
GDeadspace to Tidal Volume Ratio (V[subscript D]/V[subscript T])586
HMean Airway Pressure (MAWP)587
IMinute Ventilation: Expired and Alveolar587
JShunt Equation (Q[subscript sp]/Q[subscript T]): Classic Physiologic588
KShunt Equation (Q[subscript sp]/Q[subscript T]): Estimated589
LVentilator Rate Needed for a Desired PaCO[subscript 2]589
MWeaning Index: Rapid Shallow Breathing590
NWeaning Index: Simplified591
Appendix 2Dubois Body Surface Chart592
Appendix 3Pressure Conversions593
Appendix 4French (Fr) and Millimeter (mm) Conversions594
Appendix 5Normal Electrolyte Concentrations in Plasma595
Appendix 6Oxygen Transport Normal Ranges596
Appendix 7Hemodynamic Normal Ranges597

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