RT Book, Section
A1 Esan, Adebayo
A1 Khusid, Felix
A1 Raoof, Suhail
A2 Oropello, John M.
A2 Pastores, Stephen M.
A2 Kvetan, Vladimir
SR Print(0)
ID 1136413822
T1 Ventilator Technology and Management
T2 Critical Care
YR 1
FD 1
PB McGraw-Hill Education
PP New York, NY
SN 9780071820813
LK accessmedicine.mhmedical.com/content.aspx?aid=1136413822
RD 2024/04/23
AB KEY  POINTSThe  goals  of  mechanical  ventilation  are  to  provide  safe  gas  exchange,  decrease  the  work  of  breathing,  improve  patient–ventilator  interactions,  minimize  iatrogenic  injury,  and  promote  liberation  from  mechanical  ventilation  in  a  timely  manner.Mechanical  ventilation  is  indicated  in  individuals  who  are  unable  to  sustain  normal  gas  exchange  as  a  result  of  established  or  impending  respiratory  failure  from  hypoxemia,  hypercapnia,  or  both;  airway  problems,  and  to  provide  support  to  individuals  undergoing  general  anesthesia.A  ventilator  mode  can  be  classified  by  specifying  the  control  variable,  breath  sequence,  and  targeting  scheme.Conventional  modes  of  ventilatory  support  include  continuous  mandatory  ventilation,  assist-control  ventilation,  intermittent  mandatory  ventilation  and  synchronized  intermittent  mandatory  ventilation,  and  pressure  support  ventilation.Alternative  modes  of  ventilatory  support  include  dual  control  modes,  such  as  volume-assured  pressure  support  or  pressure  augmentation,  volume  support  ventilation  or  variable  pressure  support  ventilation,  pressure-regulated  volume  control  and  auto  mode  ventilation.Nonconventional  modes  of  ventilatory  support  include  airway  pressure  release  ventilation,  proportional  assist  ventilation,  adaptive  support  ventilation,  neurally  adjusted  ventilatory  assist,  and  high-frequency  ventilation  including  high-frequency  oscillatory  ventilation  and  high-frequency  percussive  ventilation.Monitoring  during  mechanical  ventilation  includes  measurement  of  peak  and  plateau  pressures,  intrinsic  positive  end-expiratory  pressure,  and  work  of  breathing.Prerequisites  prior  to  conducting  a  spontaneous  breathing  trial  include  partial  or  complete  recovery  of  conditions  that  resulted  in  respiratory  failure;  adequate  oxygenation  with  low  PEEP,  that  is,  PaO2/FIO2  more  than  200,  PEEP  ≤  8  cm  H2O,  and  FIO2  ≤  0.5;  absence  of  severe  acidosis  (pH  ≥  7.25);  hemodynamic  stability  with  minimal  or  no  vasopressor  support;  and  presence  of  spontaneous  inspiratory  effort.Noninvasive  positive  pressure  ventilation  avoids  complications  of  invasive  ventilation  (eg,  trauma,  cardiac  arrhythmias,  hypotension,  volutrauma,  and  ventilator-associated  pneumonia).Indications  for  noninvasive  positive  pressure  ventilation  include  acute  hypercapnic  respiratory  failure  in  the  setting  of  chronic  obstructive  pulmonary  disease  (COPD)  and  cardiogenic  pulmonary  edema  and  immunosuppressed  patients  with  pulmonary  infiltrates,  fever,  and  acute  respiratory  failure.