Respiratory System and Artificial Ventilation

295 Pages·2008·2.48 MB·English

by  F. B. Santos

Respiratory System and Artificial Ventilation
Umberto Lucangelo • Paolo Pelosi
Walter A. Zin • Andrea Aliverti
Respiratory System
and Artificial Ventilation
1 3
Editors
Umberto Lucangelo Paolo Pelosi
Department of Perioperative Medicine Department of Clinical Science
Intensive Care and Emergency University of Insubria
Cattinara Hospital Varese,Italy
Trieste University School of Medicine
Trieste,Italy
Walter A. Zin Andrea Aliverti
Laboratory of Respiration Physiology TMB Laboratory
Carlos Chagas Filho Institute of Biophysics Department of Bioengineering
Federal University of Rio de Janeiro Politecnico di Milano
Rio de Janeiro,Brazil Milan,Italy
Library of Congress Control Number:2007939294
ISBN 978-88-470-0764-2 Milan Heidelberg New York
e-ISBN 978-88-470-0765-9
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Preface
Intellectual undertakings, such as publishing a medical book—in this case, one
concerning the respiratory tract and artificial support techniques—offer an
important incentive for experts in a particular field,in that,as authors,they have
the opportunity to share research results,whether their own or those of the work-
ing group they represent. Such books provide challenging and qualified updates
to young researchers, who are thereby able to enhance their knowledge and
working methods, for example, with the aim of improving the treatment stan-
dards of intensive-care patients.
The purpose of this book is to pursue the mission undertaken for the past thir-
ty years by the Trieste University School of Anaesthesia and Intensive Care and,
more recently, by the School of Anaesthesia and Intensive Care of Catania
University.
The editors’ task was made easier through a project promoted by the
University of Catania, which involved the presence in Catania of my colleague
Walter Zin, from Rio de Janeiro, who held a series of lectures and seminars on
respiratory pathophysiology, aimed at teachers and students alike. Furthermore,
important contributions by my colleagues Paolo Pelosi, from Varese; Andrea
Aliverti, from Milan; and Umberto Lucangelo, from Trieste, must also be
acknowledged. Their valuable co-operation and support contributed to achieving
the high quality of this book.
The 18 chapters that make up this volume were written by highly regarded
and internationally known clinical experts and researchers. To facilitate access
to the information provided in the chapters,the volume has been subdivided into
the following sections: Properties of the Respiratory System; Interaction
Between the Pulmonary Circulation and Ventilation; Monitoring of Respiratory
Mechanics, Acute Lung Injury–ARDS, Controlled Mechanical Ventilation in
ARDS and the Open-Lung Concept; Nosocomial Pneumonia; Prone Ventilation;
VI Preface
Old and New Artificial Ventilation Techniques; Non-invasive Ventilation.
‘Respiratory System and Artificial Ventilation’serves as a valuable tool for con-
tinuing medical education and for updating one’s state-of-the-art clinical knowl-
edge.
Venice,November 9,2007
Antonino Gullo
Head and Chairman,
Department and School of Anaesthesia and Intensive Care,
University of Catania - Italy
Council,World Federation of Societies of Intensive and Critical Care
Medicine (WFSICCM)
Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IX
List of Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .XIII
Properties of the Respiratory System
1. Control of Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
F.B. Santos,L.K.S. Nagato,W.A. Zin
2. Elastic and Resistive Properties of the Respiratory System . . . . . . . . 15
W.A. Zin
3. Flow Limitation and its Determination . . . . . . . . . . . . . . . . . . . . . . . . . 27
W.A. Zin,V.R. Cagido
4. Intrinsic PEEP and its Determination . . . . . . . . . . . . . . . . . . . . . . . . . . 37
W.A. Zin,V.R. Cagido
Interactions Between Pulmonary Circulation and Ventilation
5. Interactions Between the Pulmonary Circulation and Ventilation:
An Overview for Intensivists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
A.F. Broccard,F. Feihl
Monitoring of the Respiratory Mechanics
6. Monitoring of Respiratory Mechanics in the ICU:
Models,Techniques and Measurement Methods . . . . . . . . . . . . . . . . . 73
A. Aliverti
Acute Lung Injury–ARDS, Controlled Mechanical Ventilation in
ARDS and the Open Lung Concept
7. Pathophysiology of ARDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
D. Chiumello,C.S. Valente Barbas,P. Pelosi
VIII Contents
8. Ventilator-Associated Lung Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . .119
E. Crimi,L. Del Sorbo,V.M. Ranieri
9. Controlled Mechanical Ventilation in ARDS . . . . . . . . . . . . . . . . . . . .139
U. Lucangelo,S. Gramaticopolo,B. Bacer
10. The Open Lung Concept in Cardiac Surgery Patients . . . . . . . . . . . .153
C. Preis,D. Gommers,B. Lachmann
Nosocomial Pneumonia
11. Diagnosis and Treatment of Nosocomial Pneumonia . . . . . . . . . . . . . .167
A. Liapikou,M. Valencia,A. Torres
Prone Ventilation
12. Prone Ventilation To Prevent Ventilator-Associated Pneumonia . . . .191
P. Beuret
13. Prone Positioning of Patients with ARDS . . . . . . . . . . . . . . . . . . . . . . .197
L. Blanch,U. Lucangelo
14. Prone Ventilation in Trauma Patients . . . . . . . . . . . . . . . . . . . . . . . . . .209
G. Voggenreiter
Old and New Artificial Ventilation Techniques
15. Advanced Modalities in Negative-Pressure Ventilation . . . . . . . . . . . .221
V. Antonaglia,S. Pascotto,F. Piller
16. High-Frequency Percussive Ventilation . . . . . . . . . . . . . . . . . . . . . . . . .237
U. Lucangelo,S. Gramaticopolo,L. Fontanesi
Non-invasive Ventilation
17. Non-invasive Ventilation in Patients with Acute Respiratory
Failure and COPD or ARDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .247
G. Hilbert,F. Vargas,D. Gruson
18. Non-invasive Respiratory Assistance in Paediatric Patients . . . . . . . .277
G. Chidini,D. d’Onofrio,E. Calderini
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297
Contributors
Aliverti A.
TMB Laboratory,Department of Bioengineering,Politecnico di Milano,
Milan,Italy
Antonaglia V.
Biomechanics Laboratory,Department of Perioperative Medicine,Intensive Care
and Emergency,Azienda Ospedaliera-Universitaria,Trieste,Italy
Bacer B.
Department of Perioperative Medicine,Intensive Care and Emergency,Trieste
University School of Medicine,Cattinara Hospital,Trieste,Italy
Beuret P.
Intensive Care Unit,Centre Hospitalier,Roanne,France
Blanch L.
Critical Care Center,Hospital de Sabadell,Institut Universitari Fundació Parc
Taulí,Universitat Autònoma de Barcelona,Barcelona,Spain
Broccard A.F.
University of Minnesota,Medical Intensive Care Unit and Critical Care Division,
Regions Hospital,St Paul,USA
Cagido V.R.
Laboratory of Respiration Physiology,Carlos Chagas Filho Institute of
Biophysics,Federal University of Rio de Janeiro,Rio de Janeiro,Brazil
Calderini E.
Pediatric Intensive Care Unit,Department of Anesthesia and Critical Care,
Fondazione Policlinico Mangiagalli Regina Elena IRCCS,Milan,Italy
Chidini G.
Pediatric Intensive Care Unit,Department of Anesthesia and Critical Care,
Fondazione Policlinico Mangiagalli Regina Elena IRCCS,Milan,Italy
X
Contributors
Chiumello D.
Institute of Anaesthesia and Critical Care,University of Milan,Policlinico IRCCS
Hospital,Milan,Italy
Crimi E.
Interdepartmental Division of Critical Care Medicine,Division of Respirology,
St. Michael’s Hospital,University of Toronto,Canada
Del Sorbo L.
Interdepartmental Division of Critical Care Medicine,Division of Respirology,
St. Michael’s Hospital,University of Toronto,Canada
d’Onofrio D.
Department of Environment,Health and Safety,University of Insubria,
Varese,Italy
Feihl F.
Division of Clinical Pathophysiology,Lausanne University Hospital (CHUV),
Lausanne,Switzerland
Fontanesi L.
Department of Perioperative Medicine,Intensive Care and Emergency,Trieste
University School of Medicine,Cattinara Hospital,Trieste,Italy
Gommers D.
Department of Anaesthesiology and Department of Intensive Care,Erasmus-MC,
Rotterdam,The Netherlands
Gramaticopolo S.
Department of Perioperative Medicine,Intensive Care and Emergency,Trieste
University School of Medicine,Cattinara Hospital,Trieste,Italy
Gruson D.
Department of Medical Intensive Care,University Hospital of Bordeaux,
Bordeaux,France
Hilbert G.
Department of Medical Intensive Care,University Hospital of Bordeaux,
Bordeaux,France
Lachmann B.
Department of Anaesthesiology,Erasmus-MC,Rotterdam,The Netherlands
Liapikou A.
Respiratory Intensive Care Unit,Pulmonology Department,Hospital Clinic of
Barcelona,Barcelona,Spain