Core topics in mechanical ventilation PDF
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This page intentionally left blank Core Topics in Mechanical Ventilation i IainMackenzieinzero-gravitytrainingforProfessorHawking’sflight,April26,2007. Core Topics in Mechanical Ventilation Edited by IAIN MACKENZIE ConsultantinIntensiveCareMedicine andAnaesthesia CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521867818 ©Cambridge University Press 2008 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2008 ISBN-13 978-0-511-45164-5 eBook (Adobe Reader) ISBN-13 978-0-521-86781-8 hardback Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this book to provide accurate and up-to- date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Never theless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. Contents Contributors page vii ForewordbyTimothyW.Evans ix Preface xi IntroductoryNotes xiii 1. Physiologyofventilationandgasexchange 1 HUGHMONTGOMERY 2. Assessingtheneedforventilatorysupport 21 MICKNIELSENANDIAINMACKENZIE 3. Oxygentherapy,continuouspositiveairwaypressureandnon-invasiveventilation 32 IANCLEMENT,LEIGHMANSFIELDANDSIMONBAUDOUIN 4. Managementoftheartificialairway 54 PETERYOUNGANDIAINMACKENZIE 5. Modesofmechanicalventilation 88 PETERMACNAUGHTONANDIAINMACKENZIE 6. Oxygenation 115 BILLTUNNICLIFFEANDSANJOYSHAH 7. Carbondioxidebalance 142 BRIANKEOGHANDSIMONFINNEY 8. Sedation,paralysisandanalgesia 160 RUSSELLR.MILLERIIIANDE.WESLEYELY 9. Nutritioninthemechanicallyventilatedpatient 184 CLAREREID 10. Mechanicalventilationinasthmaandchronicobstructivepulmonarydisease 196 DAVIDTUXENANDMATTHEWT.NAUGHTON v Contents 11. Mechanicalventilationinpatientswithblast,burnandchesttraumainjuries 210 WILLIAMT.MCCBRIDEANDBARRYMCCGRATTAN 12. Ventilatorysupport:extremesolutions 222 ALAINVUYLSTEKE 13. Helioxinairwayobstructionandmechanicalventilation 230 HUBERTTRU¨BEL 14. Adverseeffectsandcomplicationsofmechanicalventilation 239 IAINMACKENZIEANDPETERYOUNG 15. Mechanicalventilationfortransport 284 TERRYMARTIN 16. Specialconsiderationsininfantsandchildren 296 ROBROSSRUSSELLANDNATALIEYEANEY 17. Tracheostomy 310 ABHIRAMMALLICK,ANDREWBODENHAMANDIAINMACKENZIE 18. Weaning,extubationandde-cannulation 331 IAINMACKENZIE 19. Long-termventilatorysupport 372 CRAIGDAVIDSON 20. Thehistoryofmechanicalventilation 388 IAINMACKENZIE Glossary 404 Index 411 vi Contributors SimonBaudouin,FRCP SimonFinney,PhDMRCPFRCA SeniorLecturer ConsultantinIntensiveCareMedicineand DepartmentofAnaesthesiaandCriticalCare Anaesthesia Medicine RoyalBromptonandHarefieldNHSTrust RoyalVictoriaInfirmary London,UK Newcastle-upon-Tyne,UK BrianKeogh,FRCA ConsultantinIntensiveCareMedicineand AndrewBodenham,FRCA Anaesthesia ConsultantinAnaesthesiaandIntensiveCare RoyalBromptonandHarefieldNHSTrust Medicine London,UK LeedsGeneralInfirmary Leeds,UK IainMackenzie,DMMRCPFRCA ConsultantinIntensiveCareMedicineand IanClement,PhDMRCPFRCA Anaesthesia ConsultantinAnaesthesiaandIntensive JohnFarmanIntensiveCareUnit Medicine Addenbrooke’sHospital DepartmentofAnaesthesiaandCriticalCare Cambridge,UK Medicine PeterMacnaughton,MDMRCPFRCA RoyalVictoriaInfirmary ConsultantinIntensiveCareMedicineand Newcastle-upon-Tyne,UK Anaesthesia PlymouthHospitalsNHSTrust CraigDavidson,FRCP Derriford Director,LaneFoxRespiratoryUnit Plymouth,UK Guy’sandSt.Thomas’NHSFoundationTrust AbhiramMallick,FRCA London,UK ConsultantinAnaesthesiaandIntensiveCare Medicine E.WesleyEly,MDMPH LeedsGeneralInfirmary ProfessorandAssociateDirectorofAging Leeds,UK Research DivisionofAllergy,Pulmonary,andCriticalCare LeighMansfield Medicine SeniorPhysiotherapist VanderbiltUniversitySchoolofMedicine DepartmentofAnaesthesiaandCriticalCare VeteransAffairs,TennesseeValleyGeriatricResearch, Medicine Education,andClinicalCenter RoyalVictoriaInfirmary Nashville,Tennessee,USA Newcastle-upon-Tyne,UK vii Listofcontributors TerryMartin,MScFRCSFRCA RobRossRussell,MDFRCPCH ConsultantinAnaesthesiaandIntensiveCare ConsultantinPaediatricIntensiveCareMedicine TheRoyalHampshireCountyHospital Addenbrooke’sHospital Winchester,UK Cambridge,UK WilliamT.McBride,BScMDFRCAFFARCS(I) SanjoyShah,MDMRCPEDIC ConsultantCardiacAnaesthetist ConsultantinIntensiveCareMedicine RoyalVictoriaHospital UniversityHospitalWales Belfast,UK Cardiff,UK BarryMcGrattan,FFARCS(I) HubertTru¨bel,MD SpecialistRegistrarinAnaesthesia ConsultantinPaediatrics RoyalVictoriaHospital DepartmentofPaediatrics Belfast,UK HELIOSKilinikumWuppertal UniversityofWittenburg/Herdeche RussellR.MillerIII,MDMPH Wuppertal,Germany AssistantProfessor DivisionofCriticalCareandPulmonaryMedicine LDSandIMCHospitals BillTunnicliffe,FRCA UniversityofUtahSchoolofMedicine ConsultantinIntensiveCareMedicineand SaltLakeCity,Utah,USA Anaesthesia QueenElizabethHospital HughMontgomery,MDFRCP Birmingham,UK Director,InstituteforHumanHealthand PerformanceandConsultantIntensivist DavidTuxen,MBBSFRACPMDDipDHMFJFICM UCLHospitals AssociateProfessorofCriticalCare London,UK TheAlfredHospital Prahran MatthewT.Naughton,MDFRACP Melbourne,Australia AssociateProfessorofHead,GeneralRespiratory andSleepMedicine AlainVuylsteke,MDFRCA TheAlfredHospital DirectorofCriticalCare Prahran PapworthHospitalNHSTrust Melbourne,Australia PapworthEverard Cambridgeshire,UK MickNielsen,FRCA ConsultantinAnaesthesiaandIntensiveCare NatalieYeaney,MDFAAP SouthamptonUniversityHospitalsNHSTrust ConsultantNeonatalIntensivist Southampton,UK Addenbrooke’sHospital ClareReid,PhDSRD Cambridge,UK ResearchDietician DivisionofAnaesthesia PeterYoung,MDFRCA UniversityofCambridge ConsultantinIntensiveCareandAnaesthesia Addenbrooke’sHospital TheQueenElizabethHospital Cambridge,UK King’sLynn,UK viii
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