Pediatric and Neonatal Mechanical Ventilation Praveen Khilnani
INDEX
ABCDEFGHIJLMNOPRSTUVW
Page numbers followed by f refer to figure, fc refer to flow chart, and t refer to table
A
Abscesses, multiple 119f
Accidental extubation, chances of 37
Acid-base disorders 128, 129t
Acidemia 128
Acidosis 53, 129
acute respiratory 129
chronic respiratory 129
metabolic 36, 129
severe lactic 38
Activated clotting time 207
Acute respiratory distress syndrome 1, 26, 35, 36, 101, 117, 127, 200
Adaptive pressure
control 98
ventilation 98
Adaptive support ventilation 98, 99, 107
Adult respiratory care system 65
Air 64
entry 82
high-flow 72f
leak 36, 134, 136f
cold light for 82
persistent 203
syndromes 93
Airway 193
clearance 46
disease, obstructive 117
function, preserves 69
obstruction 25, 52, 62
lower 117
pressure 4, 20
high 105
release frequency 104
release ventilation 98, 102, 102t, 103f, 154, 155f
reflexes, control of 14
resistance 7
size 106
type 106
Albuterol 37
Alkalemia 128
Alkalosis
acute respiratory 129
chronic respiratory 129
metabolic 129
Alveolar
arterial gradient 203
derecruitment 27
minute ventilation 2
plateau 133
pressure minus ambient pressure 16
recruitment 27
Ambient pressure minus pleural pressure 16
American Heart Association Guidelines 141
American Thoracic Society Guidelines 183
Analgesia 173, 180, 207
Anasarca 20
Antibiotics 207, 208
Anticoagulation 207, 209
Anxiety 118
Apnea 3, 10, 48, 117, 195, 225, 228
frequent 4
monitor 82
of prematurity 61, 67, 82, 117
rule out other causes of 62
ventilation 231
Arrhythmias
cardiac 195
intractable 204
refractory 204
Arterial blood 203
adequate 48
gas 118, 122
monitoring 127
Arterial lines 118
Arterial oxygen, partial pressure of 23, 43
Arterial oxygenation 27
Arteries, dilate pulmonary 52
Artificial airway, resistance of 166
Artificial noses 176
Ascites 20
Aspiration, subglottic 186
Assist control ventilation 99
Assist ventilation 78f
mode 105f
Asthma 1, 117
childhood 38
severe 35, 37, 40, 47
Asynchrony
identify signs of 144, 163
types of 171
Atelectasis 69
Auto-positive end-expiratory pressure 164f
B
Barotrauma 11, 36, 52, 72, 233
acute 38
Beer-Lambert law 123
Bilevel airway pressure release ventilation 224
Bilevel nasal continuous positive airway pressure 114
Bilevel positive airway pressure 67, 99, 114, 116
Bleeding 210
Blended gas source 57
Blocked nasal passages 68
Blood
flow, pulmonary 29
gas 61, 83
capillary 83
target 82
pressure 77
noninvasive 118
Bloodstream infection
catheter-related 180
central line-associated 180
Botulism 24
Brain 44
injury, traumatic 30, 42
Breath 76
cycle time 228
delivery 19
identify type of 144, 148
sounds 122
to-breath
analysis 104f
pressure 100fc
Breathing
circuit, humidifier 64
eliminate work of 3
paradoxical 122
periodic 171
reducing work of 70
work of 18, 61, 79, 163
Bronchi 2
Bronchiolitis 117, 67
severe 203
Bronchodilator 161f
Bronchospasm 11, 123
Bubble nasal continuous positive airway pressure 59f
Bulk convection 89
C
Caffeine 192
Capnogram
waveform 133
normal 126f
Capnograph, normal 134f
Capnography 125, 127, 131, 132, 139f
basic principle of 131
indications for 126
Capnometers, qualitative 133
Capnometry 131, 133
efficacy of 140
Carbon dioxide 89, 102, 132f
monitoring 123
monitors measure 131
partial pressure of 131
removal 207
systemic arterial 18
Carboxyhemoglobin 124
Cardiac arrest 38
Cardiac extracorporeal membrane oxygenation 203
Cardiac failure
congestive 48
situations, acute reversible refractory 203
Cardiac index 204
Cardiac output 233
Cardiomyopathy 40
Cardiopulmonary arrest 202
Cardiorespiratory arrest 31
Cardiorespiratory interactions 40, 41
Cardiothoracic surgery 201
Cardiovascular dysfunction 24
moderate to severe 24
Catecholamines 134
Central hypoventilation syndrome 4, 117
Central nervous system 189
protection 174, 182
severe 203
Central venous
oxygen saturation 204
pressure 44
Cerebral
blood flow 44, 77
ischemia 44
palsy 117
Cerebrospinal fluid 43
Cervical spine injuries 42
Chest
bandages 20
indrawing, degree of 73
physiotherapy 177, 178, 192
syndrome, acute 203
trauma 72
wall movement 82
wiggle factor 111
X-ray 50, 82
Choanal atresia 68, 72
Circulatory arrest 134
Clinical pulmonary infection score 184
Close suction system 179f
Clubbing 122
Coma 38
Complete oxygen analyzer 73f
Compliance curve 99
Compressions, cardiac 140
Congenital heart disease
postoperative
case of 35
management after repair of 28
Consciousness, reduced level of 72
Continuous end-tidal carbon dioxide monitoring, use of 142
Continuous positive airway pressure 4f, 5, 26, 48, 56, 57, 58, 61, 62, 67, 68t, 75, 99, 114, 115, 191, 195, 219, 220, 227
delivery 57
effects of 57
failure of 62
interfaces 57
system, components of 57, 57t
Conventional mechanical ventilation 50
failure of 233
Cough 35, 44
Craniofacial malformations 117
Croup 25
Cyanosis 82, 122
D
Dead space
calculation 138
ventilation 3
Deflation, physiology of 16
Deoxyribonuclease 179
Diaphoresis 195
Diaphragm, electrical activity of 217
Differential leukocyte count 184
Distress, early sign of 122
Down syndrome 117
Downe's score 81, 82t
Drager Babylog 8000 plus 220, 225f, 226, 226f
Drugs 24
Duchenne muscular dystrophy 117
Dynamic pressure-volume loop 157, 158f
Dyshemoglobinemias 124
Dysplasia, bronchopulmonary 83, 93, 189, 193
E
Edema, pulmonary 56
Elective high-frequency oscillatory ventilation 93
Electrical muscle stimulation 141
Electrocardiogram 118
Electroencephalogram 182
Emphysema, pulmonary interstitial 93, 95, 193
Empyema 119f
Encephalopathy, hypoxic ischemic 82
End-expiratory lung volume 111
Endotracheal airway, invasive 114
Endotracheal intubation 31
Endotracheal tube 2, 75, 94, 106, 131, 188, 218
leak
around 163f
large 163
placement, verification of 140
size of 76t
weight of 76t
End-tidal carbon dioxide 12, 122, 142
high 134, 135f
monitors, types of 133
sudden rise of 134, 135f
Engström ventilator 223, 224f
Epiglottitis 25
Epinephrine, nebulized racemic 192
Esophageal surgery 117
Exhaled tidal volume 223
Expiratory time 78, 147f, 226, 230
Expired minute volume 5
Expired tidal volume 5
Extracorporeal cardiopulmonary resuscitation 205
Extracorporeal Life Support Organization Guidelines Regarding Extracorporeal Membrane Oxygenation Centers 211
Extracorporeal Life Support Organization Registry Analysis 211
Extracorporeal life support, development of 199
Extracorporeal membrane oxygenation 94, 198, 199, 201, 204, 205, 206f, 207f, 212, 233
complications of 209
current status of 205t
flows, weaning 207, 209
indications of 201
initiation of 208
management 207
summary 209
program, setting up 211
selection criteria for cardiac support 204
support, methods of 200
technique of 205
Extubation 14
failure, causes of 188, 189t
readiness
clinical indicators of 14
test 194
F
Fat laden superficial fascia 56
Feeding 173, 181
Fetal hemoglobin 124
Fever 44
high-grade 35
Figure-of-eight appearance 169f
Flow
and volume starvation 168f
asynchrony 163, 168
cycle
breath 19
ventilation 78, 79f
monitoring 226
pattern 230
rate 81, 132
sensitivity 230
sensor 77, 218
starvation 146
volume loop 85, 86f, 160, 164f
waveform 147, 148f
Fluids 52
interstitial 43
Fontan procedure 29
Foreign body aspiration 72
Fraction of inspired oxygen 203
Frank-Starling curve 41
Friction rub 122
Functional residual capacity 17, 42, 56, 148
G
Gas exchange 3, 10
abnormal 3
determinants of 18
principles of 89
Gas flow 1, 58
mechanism of 22
patterns of 21
Gas warming and humidification, importance of 69
Gastric
distension 60
surgery 117
Glasgow coma
scale 42
score 4
Glucose 134
Gram's satin 184
Guillain-Barré syndrome 24
H
H1N1 200, 202, 210, 211
influenza 201
Head box oxygen 191
Heart 40
failure 28
congestive 28, 67
rate 73, 81
Heat and moisture exchanger 174–176
Heated humidified high flow nasal cannula system 64
components of 64
Hemorrhage
intraventricular 77, 95, 233
periventricular 189
pulmonary 87
Hernia, congenital diaphragmatic 203, 210
High-flow nasal cannula 58, 66f, 68f
devices 116
oxygen therapy 64, 74
pressure 70
therapy 64
High-frequency oscillators 89, 91
ventilator 232
High-frequency ventilation 22, 89, 217, 220, 225
adverse effects of 95
indications for 93
types of 90
Home ventilation 45
Humidified high-flow nasal cannula 114, 116
Hyaline membrane disease 10, 48, 80, 117, 199
Hyperalimentation 134
Hypercapnia 45, 51, 104
chronic 24
tolerate 51
permissive 11, 27, 36, 39, 83, 104
Hypercarbia 3, 10, 30, 31, 43
Hyperinflation 28
dynamic 38, 162
persistent 39
Hypertension 195
neonatal persistent pulmonary 2
pregnancy-induced 49
pulmonary 181
reactive pulmonary 203
reversible pulmonary 204
Hypertensive crises, pulmonary 181
Hyperthermia 134
Hypertrophy, adenotonsillar 117
Hyperventilation 29, 43
Hypocapnea 233
Hypocarbia 43
Hypoplasia, pulmonary 93
Hypotension 40, 195, 233
sudden 134
Hypoventilation 3, 11, 45, 114
Hypovolemia 40
Hypoxemia 1, 3, 10, 11, 30, 40, 66, 103, 127
permissive 11
refractory 38, 40
severe 31
Hypoxia 52, 53
life-threatening 72
Infections
control procedures 173, 180
nosocomial 36
pulmonary 69
I
Infectious Diseases Society of America Guidelines 183
Inflation, physiology of 16
Influenza A 200
Initial ventilator settings 9, 22, 103, 109
Injury, pharyngeal 42
Inspiration, beginning of 150
Inspiratory flow 218, 226
Inspiratory limb, bowing of 158f
Inspiratory minute volume 228
Inspiratory tidal volume 228
Inspiratory time 5, 10, 22, 49, 50, 77, 78, 80, 147f, 218, 226, 230
Inspired oxygen
concentration 100
determines oxygenation 154
fraction 38
Intensive care unit 173, 200, 215
Intermittent positive pressure
breathing 114
ventilation 191
Interpret pressure-volume loop 144
Intra-aortic balloon pulsation 204
Intracranial pressure 43, 140
basic premises of 43
high 29
Intubation 75
Invasive monitoring 81, 83, 127
Invasive ventilation 50, 144
initiation of 75
J
Jet ventilation, high-frequency 90
L
Laryngomalacia 1
Leak test 195
Lethargy 118
Leukomalacia, periventricular 95, 189
Loose stools 44
Low birth weight 188
Low-cardiac output syndrome 204
Lower inflection point 27, 156
Lower limbs, sudden onset weakness of 44
Lower respiratory tract 183
Low-flow systems 132
Low-functional residual capacity 1
Low-peak expiratory flow 164f
Low-tidal volume strategy 36
Lung 41
capacities 17
compliance 7, 203
worsening 123
contusions, post-traumatic 203
disease
chronic 36
obstructive 135, 137f
parenchymal 26
function monitoring 226
inflation 16
injury,
acute 101, 127
ventilator induced 83
mechanics 70
normal 22, 152f
opening pressure 156
overdistension of 39f, 123
volumes 17
M
Magnesium 37
Mainstream devices 131
Mandatory minute ventilation 98, 109, 227
Masimo pulse oximetry 125
Masimo signal technology 125
Mass median aerodynamic diameter 174
Maxillofacial trauma 72
Maximal medical therapy 202
Mean airway pressure 4, 5, 27, 39, 91, 147, 147f, 219, 226
Mean arterial pressure, high 102
Mechanical ventilation 4, 13, 18, 23, 24, 34fc, 37, 40, 42, 47, 75, 188, 215
applied respiratory physiology of 16
basic of 1
disease specific 35
indications of 3
modified conventional 90
optimal management of 49
principles of 18
strategies 35
support 31, 46
Meconium
aspiration 35, 48, 51
syndrome 51, 52, 81, 82, 93, 198
stained liquor 51
Mental status
impaired 117
worsening 118
Meter dose inhaler 13, 175
Methemoglobin 124
Midazolam 12, 75, 180
Mini-bronchoalveolar lavage 183
Minimal pressure support 14
Minute ventilation 87
Monro-Kellie hypothesis 43
Murray's score 203
Muscle
inspiratory 20
relaxation 181
Myelitis, transverse 24
Myocarditis 204
N
Nasal cannula 66, 67f
low-flow 68t
oxygen 66
sizes 65, 67t
Nasal continuous positive airway pressure 191
devices 57
indications for 60
initiation of 61
problems of 59
Nasal flaring 195
Nasal interface 61
types of 58f
Nasal intermittent mandatory ventilation 60, 191
Nasal intermittent positive pressure 48
ventilation 56, 60, 116, 191
delivery of 60
Nasal obstruction 72
Nasal polyps 72
Nasal septal injury 60
Nasal trauma 59
Nasogastric tube in situ 73
Nasopharyngeal continuous positive airway pressure 70
Nasopharyngeal space, mucosal tissue of 69
Nasopharynx 68, 70
Near drowning 203
Nebulization 13
Neonatal hyaline membrane disease 2
Neonatal intensive care unit 61, 64, 81, 188, 199, 220
Neonatal respiratory distress syndrome 35, 49
Neonatal ventilation 48
conventional 48
settings 81
Neonatal ventilator, basic 218
Nerve conduction velocity 45
Neurally adjusted ventilatory assist 109, 217
Neurological diseases 29
Neurological disorders 24
Neuromuscular disease 29, 35, 44, 117
Neuromuscular disorder 24
chronic 45
progressive 45
Neuromuscular weakness 2, 46, 53
Neuroventilatory control sequence 110fc
New tracheostomy, care of 177
Nissen procedure 181
Nitric oxide 199
inhaled 198
Noise pollution 95
Nonbronchoscopic lower respiratory tract sampling 183
Noninvasive monitoring 81, 82, 123
Noninvasive positive pressure
devices 114
ventilation, nocturnal 46
Noninvasive ventilation 45, 47, 114, 115, 117, 118, 120, 188, 225, 227
acute 118
advantages of 115
applications of 117
discontinue 118
equipment 115
techniques 115
use of 114
Noninvasive ventilator bilevel positive airway pressure 222
O
Obesity 20
Open chest wound 72
Optiflow system 64
Oral hygiene 186
Oxygen 21
blender 64
concentration
chart 71, 72f
inspiratory 226
consumption, reduce 3
delivery, accurate 70
flow meter 66
homeostasis 127
in inspired gas 23
index 203
mixer loss 225
partial pressure of 2, 203
Oxygenated hemoglobin 123
Beer-Lambert law of 123
Oxygenation 2, 10, 43, 91, 93, 102, 111, 131
inadequate 3, 10, 11, 23
P
Paradoxical fall 134, 136f
Paralysis 173, 180, 181
Partial pressure support 80
Patent ductus arteriosus 56, 189
Peak airway pressure 39, 78
Peak inspiratory flow 230
Peak inspiratory pressure 4, 4f, 10, 23, 48, 49, 61, 80, 82, 101, 147f, 189, 219, 221, 226
Pediatric Academic Societies 191
Pediatric
and neonatal close suction catheters 179f
critical care 122
intensive care unit 3, 31, 64, 119, 122, 207f, 220
respiratory care system 64
Pendelluft effect 90
Pendulum shift 90f
Peripheral venous access 118
Peritoneal cavity 134
Permanent neurological disorders 24
Persistent hypoxia despite supplemental oxygen 118
Persistent pulmonary hypertension 35, 81, 82, 93
of newborn 198, 233
Pharynx 2
Pierre Robin syndrome 117
Pigments 124
Plateau pressure 19, 151
Pneumomediastinum 38
Pneumonia 1, 35, 48, 67, 116, 117, 122
bilateral 119f
health care-associated 183
hospital-acquired 183
inhalation 203
nosocomial 183
severe necrotizing 118f
types 183
ventilator associated 119, 183, 184
Pneumonitis, chemical 52
Pneumothorax 11, 36, 38, 72, 87, 93, 177, 179, 181
Poisonings 204
Poliomyelitis 117
Polymethylpentene oxygenator, low-resistance 200
Pores of Kohn 22
Positive airway pressure
biphasic 98, 103f
constant 225
expiratory 116
inspiratory 116
neonatal continuous 56
Positive end-expiratory pressure 2, 4, 4f, 19, 22, 35, 39, 40, 49, 56, 58, 61, 79, 80, 82, 100, 114, 146, 147f, 170f, 186, 190, 194, 219
effects of 44
use of 40
Positive pressure ventilation 40
high-frequency 90
ventilation, continuous 102
Postcardiac arrest 204
Post-extracorporeal membrane oxygenation care 207
Postextubation 61
respiratory failure 117
Pressure
areas around nares 72
augmentation 99
control 80, 227
mode 148, 218, 227
ventilation 98, 99, 149f, 224
controlled intermittent mandatory ventilation 103f
expiratory 116
generating device 57
inspiratory 116, 230
level 228
limited time cycled ventilation 48
pulmonary 52, 53
regulated volume control 35, 98, 99, 108, 223
sensitivity 230
support 7, 190, 227, 230
ventilation 77, 79, 80, 105, 152, 167f, 190, 216, 218, 225
targeted ventilation 159, 159f
time scalar 152f, 157f, 168f
ventilators 220, 221
volume curve 84f
volume loop 39f, 84f, 85f, 156, 156f–160f, 163f
displays 156
waveform 146, 146f
Pulmonary embolism 119f, 134
Pulse oximetry 82, 118, 122–124, 131
conventional 125
Pulsus paradoxus 38
Pump failure 25
Puritan Bennett 840
neonatal ventilator 230
pediatric-adult ventilator 230
universal ventilator 230
ventilator 229, 229f, 230
Pyomyositis 119f
R
Raised intracranial tension 2, 30
Raised peak airway pressure 144
Rapid eye movement 56
Rapid sequence intubation 31, 33fc
Rapid shallow breathing index 194
Real-time
curves 226
pulmonary graphics 144, 171
Respiration 1
accessory muscles of 122
Respiratory arrest 3, 38
Respiratory care 177
and pulmonary toilet 173, 174
protocol 12
Respiratory distress 31, 32fc, 48, 57, 67, 86, 119f
progressive 118
severity of 82t
syndrome 48, 49, 61, 82, 84, 92, 117, 199, 233
Respiratory extracorporeal membrane oxygenation 202
indication 202
selection criteria 203
Respiratory failure 3, 23, 31, 32fc, 34fc, 68
acute hypoxic 47
chronic 24
Respiratory frequency 218
Respiratory indices, monitoring of 122
Respiratory monitoring 122, 130
Respiratory muscle 25
failure, primary 25
weakness 166
Respiratory pump failure 25
Respiratory rate 73, 81, 82, 100, 126, 230
spontaneous 100
Respiratory sampling 183
Respiratory support 67
Respiratory system 19, 99
mechanics, basic 19
Respiratory therapists and technicians 233
Restrictive airway disease 117
Resuscitation
cardiac 141
cardiopulmonary 126, 140, 204
Retinopathy of prematurity, development of 83
Routine tracheostomy management 177
Routine ventilator management protocol 12
S
Scalars 145
Scorpion sting 204
Sechrist ventilator 227, 227f
Sedation 173, 180, 207
level assessment 186
Seizures 134
Sensor technology, development of 144
Sensormedics 3100A 232, 232f
Sensormedics oscillator
controls of 234t
settings of 234t
Sepsis 12, 87
Shock 3, 24, 117
cardiogenic 204
Sickle chest 203
Sidestream devices 131
Sidestream systems 132
Siemens servo-I 227, 228f
Sildenafil 199
Silverman score 81
Skin and bowel care 174, 182
Skull fracture 72
SLE 5000 220
ventilator 234
Sleep
apnea, obstructive 117
hypoventilation 46
Small air embolus 134
Smooth curved waves 136, 138f
Spinal cord
injury, acute 42
transection 24
Spinal muscular dystrophy 118f
Spontaneous breathing trial 14, 193, 194
Staphylococcal infection 119f
Status asthmaticus 47, 203
Steroids 37, 195
postnatal 191
Stress ulcer prophylaxis 186
Structured infection control protocols 180
Sweep gas flow 207
Synchronized intermittent mandatory ventilation 5f, 7, 77, 78f, 80, 99, 100, 148, 153, 154f, 189, 216, 219, 221, 224
Synchrony 8
Systemic venous circulation 40
T
Tachycardia 40, 195
Tachypnea 122
persistent 118
Target tidal volume 50, 100
Taylor dispersion 89f, 90
Tension pneumothorax 36
Terbutaline, intravenous 37
Test breath 104
Thal's procedure 181
Thoracic structures 16
Thoracostomy tube 36
Thromboelastogram 209
Tidal flow-volume 85
Tidal volume 5, 10, 85, 106, 218, 230
Total leukocyte count 184
Total lung capacity 17
Total respiratory
resistance 17
system 16
Trachea 2
Tracheal damage 95
Tracheal tube
cuff pressure 186
obstructed 134
Tracheobronchial aspiration 183
Tracheobronchomalacia 1
Tracheostomy 47, 106, 177
care 177
pediatric 177
Transairway pressure 151
Transcutaneous oxygen 123
Transport 231
care 231f
Trauma 68
Trigger asynchrony 163, 164
Tromethamine 208
Tube
displacement 87
obstruction 87, 123
U
Upper airway 1
obstruction 117, 191
occlusion, reduces 57
surgery 117
Upper gastrointestinal bleeding 117
Upper inflection point 27, 156
Urinary tract infections, catheter-associated 180
V
Vasoconstriction, pulmonary 11
Vasodilators, selective pulmonary 199
Vasopressors 52
Vena cava, inferior 205
Ventilation 2, 92, 131, 207
basic
fundamentals of 8
mechanics of 2
classification of modes of 99fc
common modes of 152
continuous mandatory 100, 216
conventional 36, 77, 225
high-frequency oscillatory 90, 91, 93, 96, 98, 110, 111f, 112t, 190, 199, 232
inadequate 3, 10, 23
index 203
intermittent mandatory 7, 61, 190, 216, 219
modes of 6, 108t, 189, 218, 224
neonatal patient-triggered 76
newer modes of 98
parameters determine oscillatory 91
plus option spontaneous breath types 230
postoperative 4, 48
pressure support mode of 160, 160f
prolonged 36
proportional assist 98, 105
volume
limited 9
support 99, 104, 104f, 108
targeted 157, 158, 158f
Ventilator 20, 215, 222
circuit, role of 184
continuous positive airway pressure 58
delivered breath 19
delivered intermittent mechanical breath 7
design 20
principles 19
functional characteristics of 20
graphics 144, 145
classification of 145
management 42, 207, 208
rate 14
synchronizes intermittent mandatory ventilation 7
technical specifications of 216
Ventilatory rate 5
Ventilatory support, strategies of 38
Venturi mask 64
Volume assured pressure support 99, 106, 107f, 108
Volume control ventilation 99, 150f, 157f, 224
Volume guarantee
pressure support 225
ventilation 225
Volume time scalar 162f, 163f
Volume waveform 148, 148f
Volutrauma 11, 36
Vomiting 118
W
Waveforms 145, 219
Weaning
methodology 13
protocols 186
strategies 188
techniques of 194
therapy 67
Wheezes 122
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