Jaypee Brothers
In Current Chapter
In All Chapters
X
Clear
X
GO
Normal
Sepia
Dark
Default Style
Font Style 1
Font Style 2
Font Style 3
Less
Normal
More
Pediatric and Neonatal Mechanical Ventilation
Praveen Khilnani
1:
Structure and Function of a Conventional Ventilator
VENTILATOR
Parts of a Ventilator
Compressor
Control Panel
Humidifier
Breathing Circuit
Terminology
Manipulation of Controls on the Ventilator
FiO2
Peak Inspiratory Pressure (PIP)
Flow Rate
Positive End Expiratory Pressure (PEEP)
Respiratory Rate (RR) or Frequency (f)
Ratio of Inspiratory to Expiratory Time (I:E Ratio)
Tidal Volume (Vt)
Pressure Support Ventilation
SUMMARY
2:
Mechanical Ventilation: Introduction and Physiology
REFERENCES
3:
Basic Fundamentals of Ventilation
REFERENCES
4:
Initiation of Ventilation
INITIATION OF VENTILATION
Indications of Mechanical Ventilation 1
Initial Ventilator Settings
Rate (Breaths/min) (f)
FiO2
PEEP
Inspiratory Time (I-time or I:E ratio)
Chose the Mode
Pressure Limited
Volume Limited
REFERENCE
5:
Maintenance of Ventilation
USE MNEMONIC: DOPE
Duration of Ventilation
REFERENCE
6:
Disease Specific Ventilation
CONTROLLED HYPERCAPNIA
Case Scenario 1
Ventilation for Acute Respiratory Distress Syndrome (ARDS)
Goals of Ventilation in ARDS
Case Scenario 2
Airleak Syndrome Pneumothorax, Bronchopleural Fistula
Ventilation Strategies
Other Modes Useful in Airleak Syndrome
Postoperative Ventilation following Open Heart Surgery
Chronic Lung Disease/Neuromuscular Weakness
Case Scenario 3
Raised ICP (Intracranial Pressure)
SUMMARY
REFERENCES
7:
Neonatal Ventilation
CONVENTIONAL NEONATAL VENTILATION4,5
Pressure Limited Time-cycled Ventilation
Disadvantages
CASE SCENARIO 1
Alternative Modes of Neonatal Ventilation
Patient Triggered Ventilation (PTV)
RESCUE STRATEGIES FOR MANAGEMENT OF NEONATAL VENTILATORY FAILURE
High Frequency Ventilation
CASE SCENARIO 2
High Frequency Jet Ventilation(HFJV)
Inhaled Nitric Oxide (INO) (also see Chapter on Nitric Oxide)
REFERENCES
REFERENCES
ADDITIONAL BIBLIOGRAPHY
8:
Ventilator Management and Respiratory Care
RESPIRATORY CARE DURING VENTILATION1
Sedation and Muscle Relaxation during Ventilation
Chest Physiotherapy (CPT)
Positioning
Percussion and Vibration
Manual Hyperinflation
Continuous Rotational Therapy
Fiberoptic Bronchoscopy (FOB)
Complications
Humidification
Heated Water Humidifier (HW)
Heated Wire Circuit
Heat and Moisture Exchangers
Aerosol Therapy (see Appendix, Page 72)
Characteristics of Aerosol Generating Device
Ventilatory Parameters
Circuit Characteristics
Position of the Device
Meter Dose Inhaler (MDI)
Mucolytics
Endotracheal Suctioning
Eye Care
SUMMARY
REFERENCES
FURTHER READING
9:
Weaning from Mechanical Ventilation
REFERENCE
10:
Complications of Mechanical Ventilation
SUMMARY
11:
Advanced Modes of Ventilation
AIRWAY PRESSURE RELEASE VENTILATION (APRV)
Strategy: Decreased PIP Increased Ti and Mean Airway Pressure
PRESSURE SUPPORT VENTILATION (PSV)
Strategy: Decreased Work of Breathing
PRESSURE-REGULATED VOLUME CONTROL (PRVC)
Strategy: Guaranteed Vt at Lowest PIP and Decreased Work of Breathing
PROPORTIONAL ASSIST VENTILATION (PAV)
Strategy: Decrease PIP and Decrease Work of Breathing, Increase Volume of Spontaneous Breaths
Nonconventional Techniques
High Frequency Ventilation
Apneic Oxygenation
Tracheal Insufflation of Oxygen
Constant Flow Ventilation
Liquid Ventilation (LV)
Altering Inspired Oxygen and Carbon Dioxide Concentration
Helium-Oxygen Mixture (Heliox)
FURTHER READING
12:
Ventilator Graphics and Clinical Applications
DEFINITIONS
Airway Pressure (Paw)
Flow (V)
Tidal Volume (Vt)
Esophageal Pressure (Pes)
Pressure Volume Curve
Flow Volume Loop
Compliance
Resistance (R)
Time Constant (TC)
Work of Breathing (WOB)
Technique of Respiratory Mechanics Monitoring11–15
Airway Pressure (Paw)
Flow
Calculated Parameters
VENTILATOR WAVEFORMS
Types of Waveforms25
Scalars
Pressure vs Time
Waveforms
Rectangular Flow Waveform (Square wave) (Fig. 12.5)
Descending Ramp Flow Waveform (Fig. 12.6)
Sine Flow Waveform (Fig. 12.7)
Rectangular Flow Waveforms Comparing Fast and Slow Space Ventilation (Fig. 12.8)
Ramp Flow Waveforms Comparing Fast and Slow Space Ventilation (Fig. 12.9)
Volume vs Time (Fig. 12.10)
LOOPS
Pressure Volume Loop
Components of a P-V Loop
Flow-Volume Loop
Components of a Flow-Volume Loop (Fig. 12.17)
Clinical Application of Flow Volume Loop
ABNORMAL WAVEFORMS
Auto-PEEP or Air Trapping (Fig. 12.19)
Increased Airway Resistance (Raw)
PIP vs Pplat (Fig. 12.20)
Decreased Lung Compliance during Volume Ventilation
Alveolar Overdistention
MODES OF VENTILATION
Scalar Waveforms of Pressure and Volume Controlled Ventilation
Scalar Waveforms during Common Modes of Ventilation in Volume-Targeted Ventilation
Controlled Mode (Fig. 12.24)
Assisted Mode (Fig. 12.25)
SIMV (Synchronized Intermittent Mandatory Ventilation) (Fig. 12.26)
SIMV with Pressure Support (PS) (Fig. 12.27)
Clinical Applications and Significance
CONCLUSIONS
REFERENCES
FURTHER READING
13:
High Frequency Ventilation
BASIC CONCEPT OF HIGH FREQUENCY VENTILATION (HFV)
Types of HFV
High Frequency Positive Pressure Ventilation (HFPPV)
High Frequency Jet Ventilation (HFJV)
High Frequency Oscillator Ventilation (HFOV)
CLINICAL APPLICATION
SUMMARY
FURTHER READING
14:
Noninvasive Ventilation
CONCLUSIONS
FURTHER READING
15:
Inhaled Nitric Oxide
SUMMARY
FURTHER READING
16:
Commonly Available Ventilators
AUTHORS COMMENTS
FURTHER READING
INDEX
TOC
Index
×
Chapter Notes
Save
Clear