Second Edition
Shaila Shodhan Kamat
MBBS DA MD (Anaesthesiology)
Professor and Head Department of Anaesthesiology Goa Medical College
Bambolim, Goa, India
Foreword
Muralidhar Kanchi
Director (Academics)
Senior Consultant and Professor (Anaesthesia and Intensive Care) Professor of International Health, University of Minnesota, USA Narayana Hrudayalaya Institute of Medical Sciences
Bengaluru, Karnataka, India
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Practical Applications of Mechanical Ventilation
First Edition : 2013
Second Edition : 2016
9789351529040
Printed at:
fm5Dedicated to
My doting Grandparents
Late Shri Narcinva Damodar Naik
and
Late Smt Laxmibai Narcinva Naik
Who, in the early 19th century
Truly understood the value of educating the girl child
and
Who always loved me more than anybody in my life...
To my Parents
Late Shri Vassudeva Naik
and
Late Smt Rekha Vassudeva Naik
For their unconditional love and faith in my abilities ….
To my Students
Who are my inspiration and strength…..
To my Patients
Whose blessings have helped me complete this book…..
To my Classmates
(GOMECO 1973, The Originals)
I am pleased to write a foreword to the second edition of book titled Practical Applications of Mechanical Ventilation, authored by Dr Shaila Kamat.
Ventilatory support is a major aspect of management of patients in operating rooms and the intensive care unit (ICU). A wide variety and mechanisms of respiratory disorders affect alveolar gas exchange and ventilation, necessitating the institution of mechanical ventilation in the ICU. The care of ventilated patients is now mature with recent advances and techniques. This book deals with not only basic information but also the recent advances in the ventilatory management of the critically ill. Such a book is highly recommended for both, the novice and the learned, to abreast them of the fundamentals and the recent trends.
The text is written in simple English which is easily understandable and is supported with self-explanatory diagrams. The forty-five chapters in the book are conveniently divided into six parts. Each part deals with a certain aspect of mechanical ventilation strategy starting with anatomy/physiology of the respiratory system and ending with ventilatory strategy in various clinical scenarios. This text is of immense value for students, physicians and health professionals who practice critical care medicine from a variety of disciplines namely anaesthesia, critical care medicine, general/cardiothoracic surgery, pulmonology and emergency medicine.
Dr Shaila Kamat is a sound clinical anaesthesiologist with extensive experience in ventilatory management in both, operating rooms and intensive care settings. What is remarkable about her is that she is a passionate teacher and prolific writer. This combination of teaching and writing capabilities makes way for a distinct publication such as this.
I sincerely wish that Dr Kamat is blessed with a long and healthy life so as to contribute to the growth of critical care medicine in the future too!
Muralidhar Kanchi MD FIACTA FICA MBA
Director (Academics)
Senior Consultant and Professor (Anaesthesia and Intensive Care)
Professor of International Health, University of Minnesota, USA
Narayana Hrudayalaya Hospitals
fm9Reviews
A good teacher can inspire hope, ignite the imagination, and instill a love for learning.
—Brad Henry
Dr Shaila Shodhan Kamat conceived the idea of writing this book, Practical Applications of Mechanical Ventilation when she watched us, as postgraduate students, struggling with the basic concepts of lung and ventilator mechanics.
Mechanical ventilation is considered a puzzling and challenging topic and the ventilator, an enigma. My teacher, Dr Shaila Shodhan Kamat, has managed to achieve the near impossible arduous task of making this subject less daunting. She has worked tirelessly for nearly ten years, researching, writing, typing, and editing, before the first book was published. The book was lucid and easy to understand, with plenty of illustrations. She has received a great response for this book.
But Dr Shaila, being a person who does not like to rest on her laurels, decided to challenge herself further. She has invested her time and energy again in the second edition of the book, and made her first edition appear like a pale shadow. The second edition is again a thoroughly researched book with some additional chapters for better understanding of the concepts and current strategies. The basics of mechanical ventilation and the various modes of ventilation are dealt with in detail yet in easily comprehendible language. The aim is to make the reader confident in handling the respiratory mechanics of any patient getting admitted in an ICU depending on the specific disorders and clinical parameters. How and when to wean a patient off the ventilator, will be infinitely clear after reading the chapter on weaning.
The book will be highly beneficial to any medical personnel interested in deciphering the world of mechanical ventilation and help them face their ICU fears with in-depth knowledge based on facts.
I take this opportunity to congratulate Dr Shaila Kamat on the completion of this second edition, for which we have seen her take painstaking efforts.
Rohini V (Bhat) Pai
Assistant Professor
Department of Anaesthesiology
Goa Medical College
fm11Preface to the Second Edition
If you salute your duty, you need not salute anybody. But if you pollute your duty, you have to salute everybody.
— Dr A. P. J. Abdul Kalam
It gives me great pleasure to publish the second edition of Practical Applications of Mechanical Ventilation. The first edition was published in 2009. I began working on this second edition in 2013. I was confident I would be able to finish writing within six to eight months. However, days, months and years passed in spite of consistent efforts. Every time I thought the content was ready, I would gain new information or insight which I thought was vital to the book. That would land me right back to my writing corner. This caused a delay in publishing this second edition.
With cutting edge and clinically relevant information, this book takes a practical, clinical approach to the principles and basics practice of mechanical ventilation. This resource explains mechanical ventilation decisions and procedures in real-world terms so information is easy to understand and apply. This thoroughly updated edition includes completely updated chapters, and a wealth of new knowledge. Each chapter has been extensively revised to reflect the latest research.
The book comprehensively covers the principles and use of mechanical ventilation, along with related pharmacological and technical issues. It is an excellent resource that implements a clinical, practical approach to the management of mechanical ventilation. It is divided into sections focusing on the technical aspects and physiology of mechanical ventilation, adjunct therapies, specialized techniques, and future therapies. The content has also been further simplified with an increased focus on critical thinking and a continued emphasis on ventilator graphics which I have drafted myself.
Friends and colleagues often asked how I have managed to work on a book, in spite of a tight work schedule. A difference of merely one degree turns water into steam, and steam moves even the largest locomotive. It is that one extra degree that makes all the difference. Similarly, it is that one extra degree of effort that has made the book possible.
I believe there are three powerful laws at work in life. These laws have helped me gain a better understanding of how our mind-set influences our success.
- The Law of Expectations (Law I):
- The Law of Attraction (Law II):Our mind is like a living magnet. Whatever we think of, is what we attract to ourselves.
- The Law of Vibrations (Law III):That is why there are times when we feel uncomfortable in a person's presence or in a particular place and vice versa. We must always contribute good, positive vibrations wherever we are. As doctors this is especially important since patients would feel comfortable to approach us and share details about their lives, which could provide essential information for diagnosis and treatment.
The most important qualities of a medical practitioner are medical knowledge, communication skills, ethics and above all compassion towards patients. Our legacy in this world is to seek perfection through new knowledge and practical experience striving to be the best in the field so as to provide optimum professional service to doctors as well as patients.
My efforts would be worthwhile if readers find this improved edition useful as a simple, concise, up-to-date guide on mechanical ventilation of the critically ill.
“Don't let the noise of others’ opinions drown out your own inner voice. And most important, have the courage to follow your heart and inner intuition”.
—Steve Jobs
fm14Acknowledgments
If the only prayer you ever say in your entire life is thank you, it will be enough.
—Meister Eckhart
Publishing a book is no mean task. Nor is it possible without the support of many hands. Though not possible to name each and every one here, I take this opportunity to acknowledge a few who saw me through this arduous but highly fulfilling task.
I am grateful to everyone who spared their precious time to provide me with valuable feedback for enhancing the book content. I am fortunate to have received valuable suggestions and have the foreword written by Dr Muralidhar Kanchi, Director (Academics), Narayana Hrudayalaya Hospitals, Bengaluru, Karnataka, India. He is not only one of the greatest anaesthesiologists; he is also a wonderful human being and my well-wisher, guide and my friend. His forewords to all my books are like a blessing in writing.
I am extremely thankful to Dr Pradeep Naik (Dean) and Dr Sunanda Amonkar (Medical Superintendent) Goa Medical College, for supporting me and my department whole heartedly.
I am extremely thankful to Dr Rohini Pai (Assistant Professor, Department of Anaesthesiology, GMC), who went out of her way to provide inputs for the book. I take this opportunity to express gratitude to all my colleagues, residents and staff of the Department of Anaesthesiology and the ICU of Goa Medical College. As each of them performed their duties sincerely, they ensured that as HOD I had peace of mind which is vital for writing a book. My loving blessings to Anaesthesiology Residents, Dr Teena Dessai and Dr Nimisha Parker who helped in improving the text.
Till date all my books have been unofficially released by my mother, Late Smt. Rekha Vassudeva Naik, in the presence of my entire family, before being released in the college. My heart aches today knowing this book will not be released by her. She always rejoiced and was proud of even my smallest achievements. Even today, I am sure she must be happy about the publication of this book and blessing me silently from wherever she is.
I am also thankful to my uncles, late Shri Anant (Babu) Naik and Damodar N. Naik, for the love and security they have showered on me throughout my life.
I want to thank my classmates (1973 GOMECO, The Originals) who form my extended family. As friends we have always stood by each other and encouraged each other's success. Over forty-three long years these ties have only become stronger. My special appreciation and thanks to my friend Dr Anton Rodrigues (Physician) who, over the last thirty years, provided timely medical help to my fm15mother, any time of the day or night, caring for her like his own mother. His kind gesture ensured I could be at ease that she was well taken care of, and focus on my work.
Behind every successful woman there is the helping hand of her husband, children and siblings. I wholeheartedly appreciate the support and patience of my husband Shodhan, my daughters Salonee Hitesh Jain and Asmani Venkatram Shirgaonkar. I am thrilled that the book cover has been designed by Asmani. I thank her for the unusual and striking design.
I am grateful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing), M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their motivating passion. Finally, the hardwork put in by the team at M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, namely, Ms Samina Khan (PA to Director–Publishing), Mr K K Raman (Production Manager), Mr Sunil Dogra (Production Executive), Mr Mohit Bhargava (Production Coordinator), Mr Pawan Kumar (Graphic Designer) and Ms Sangita Kumari (Proof Reader) is gratefully acknowledged. Their professionalism and efficiency has been remarkable and impressive.
Though I am not an overtly religious person I have always felt God's presence in my life and without his grace this book would not have been possible.
Indeed, I am grateful, thankful, blessed.