Known for its simple explanations and in-depth coverage of patient-ventilator management, this evidence-based text walks you through the most fundamental and advanced concepts surrounding mechanical ventilation and helps you understand how to properly apply these principles to patient care.
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Recap: Volume control and pressure control are the two primary control variables. Selecting the control variable is the first step in the initiation of mechanical ventilation. Then you can choose an operational mode to determine the type and amount of support the patient receives.
High-frequency oscillatory ventilation (HFOV) is a type of mechanical ventilation that delivers very small tidal volumes at an extremely fast rate, which minimizes the chances of a lung injury.
The benefits of mechanical ventilation often far outweigh the risks, which is why it is such a common intervention in the field of respiratory care. However, there are some complications that can occur.
Analgesics can be administered to provide relief for pain, while bronchodilators are used to help open the airways and reduce airflow resistance. Some examples of the types of drugs that are used for mechanical ventilation include:
There are a number of things that can go wrong during mechanical ventilation. Therefore, ventilator troubleshooting refers to the process of identifying and resolving problems in the patient-ventilator interaction.
Noninvasive mechanical ventilation is a type of support that can be applied without the insertion of an artificial airway. This type is typically used in patients with mild to moderate respiratory distress. BiPAP and CPAP are two examples of noninvasive ventilation.
Ventilator-associated pneumonia (VAP) is a type of pneumonia that is acquired 48 hours or more after intubation and the initiation of mechanical ventilation. Therefore, it is a hospital-acquired infection, meaning that it is not present at the time of admission.
In general, nurses are typically educated on the basics of mechanical ventilation. However, they are not typically trained on how to initiate or make adjustments to the ventilator settings. Therefore, this skill is not within their scope of practice.
In some cases, patients can be extubated and transitioned to a less invasive form of mechanical ventilation within a few days. However, other patients may require mechanical ventilation for several weeks or even months.
4. What are the indications for mechanical ventilation?Acute or chronic respiratory failure, oxygenation failure, pulmonary or cardiac conditions, sepsis, head injury management, nervous system disorders, and muscular weakness.
8. What are some more indications for mechanical ventilation in adults?Apnea, Impending respiratory arrest, Acute exacerbation of COPD, Acute severe asthma, Neuromuscular disease, Acute hypoxemic respiratory failure, Heart failure and Cardiogenic shock, Acute brain injury, and Flail chest.
118. What are the three groups of mechanical ventilation patients?(1) Depressed ventilatory drive (e.g. drug overdose), (2) excessive ventilatory workload (e.g. airflow obstruction), and (3) failure of ventilatory pump (e.g. chest trauma).
120. What are the objectives of mechanical ventilation?To support or manipulate pulmonary gas exchange, to normalize alveolar ventilation, to maintain arterial oxygenation, and to reduce or manipulate the work of breathing.
Understanding the principles of mechanical ventilation is essential for providing adequate support to patients with respiratory failure. The basic principles of mechanical ventilation include:
Mechanical Ventilation provides a comprehensive theoretical background and practical approach to mechanical ventilation. It is written primarily for respiratory therapists, but critical care and respiratory physicians and nurses will find many aspects of the book invaluable, particularly the clear and concise descriptions of the different modes of mechanical ventilation, their advantages and disadvantages, and a practical approach to common problems encountered during mechanical ventilation.
The book is divided into five sections. The first encompasses basic aspects of mechanical ventilation, including the history of resuscitation and mechanical ventilation, arterial blood gas interpretation, basic terminology and concepts of mechanical ventilation, ventilator graphic displays, and the physical aspects of mechanical ventilators. I found this latter section particularly useful as it provides an explanation of the 'nuts and bolts' of mechanical ventilation in a lucid and easily understandable manner. As the authors themselves bemuse, sometimes there is a bewildering display of graphic information on newer microprocessor-controlled ventilators that can be overwhelming to the uninitiated. This section demystifies this aspect of mechanical ventilators by explaining key concepts in a readily understandable manner. In addition, the section on the history of mechanical ventilation was informative and entertaining, and it helps one appreciate how rapidly this field has progressed in the past 50 years.
The second section of the book pertains to monitoring in mechanical ventilation, and discusses additional aspects of arterial blood gas analysis, calametry, and respiratory system mechanics. Hemodynamic monitoring of the ventilated patient is discussed, with particular emphasis on the effects of mechanical ventilation on these parameters. While the section provides a good basic discussion of key issues, the reader is referred to textbooks of critical care medicine for a more in-depth discussion of this area.
The third section covers the physiological and pathological pulmonary and nonpulmonary effects of mechanical ventilation, including cardiovascular, renal, and central nervous system effects. The section on pulmonary effects of mechanical ventilation includes a clear discussion of barotrauma and volutrauma, of ventilator-associated pneumonia, of oxygen toxicity, and of complications of the artificial airway. There have been many developments in this area in the past 5 years, making this section slightly out of date. The next edition of the book will no doubt be updated and expanded in this important area.
The fourth section discusses physiological aspects of acute respiratory failure and the criteria for establishment of mechanical ventilation, a practical approach to initiation of mechanical ventilation, practical aspects of ventilator set-up (including sensitivity, fraction of inspired oxygen, humidification, and alarms), assessment of the initial settings of mechanical ventilation and practical suggestions for adjusting these, use of positive end-expiratory pressure and CPAP, changing ventilator circuits, patient positioning, sedation and paralysis, and finally weaning and discontinuation of mechanical ventilation, including extubation.
The final section of the book discusses newer modes of mechanical ventilation, including high-frequency ventilation, ventilation of the pediatric patient, home ventilation, liquid ventilation, extracorporeal gas exchange, tracheal gas insufflation, and the use of nitric oxide and HeliOx. I found this to be a good introduction to a complex and evolving area but, again, slightly out of date given the rapid evolution of the field of high-frequency ventilation and liquid ventilation.
As can be appreciated, this book presents a comprehensive approach to mechanical ventilation in a straightforward (but not simplistic) manner. The textbook is well organized and provides learning objectives at the beginning of each chapter, as well as questions and answers that are particularly useful for reinforcing the concepts and for self-assessment. There are many pictures, diagrams, and tables in each section that are well thought out and assist in understanding difficult concepts. The style of writing is relaxed, which makes the book easy to read. There are many anecdotes, especially in the first section, that had me chuckling.
In summary, this is a comprehensive and easily understandable book on mechanical ventilation that will represent a valuable textbook for students and practitioners of respiratory therapy, and that will provide a valuable resource for other health professionals. I would recommend this book highly, and await eagerly the next edition. 2ff7e9595c
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