Ventilatory Failure

466 Pages·1991·12.161 MB·English

by  D. F. Rochester (auth.), Prof. Dr. J. J. Marini, Prof. Dr. C. Roussos (eds.)

15 Update in Intensive Care
and Emergency Medicine
Edited by J. L. Vincent
1. 1. Marini C. Roussos (Eds.)
Ventilatory
Failure
With 179 Figures and 59 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
Series Editor
Prof. Dr. Jean Louis Vincent
Clinical Director, Department of Intensive Care, Erasme Hospital
Free University of Brussels, Route de Lennik 808
1070 Brussels, Belgium
Volume Editors
Prof. Dr. J.J.Marini
St. Paul-Ramsey Medical Center, 640 Jackson Street
St. Paul, MN 55101-2595, USA
Prof. Dr. C.Roussos
Department of Critical Care, Evangelismos Hospital
45, Ipsilandou Street, Athens 11521, Greece
ISBN-13 : 978-3-642-84556-7 e-ISBN-13 : 978-3-642-84554-3
DOl : 10.1007/978-3-642-84554-3
Library of Congress cataloging-in-Publication Data
Ventilatory failure 1 edited by J.J.Marini and C.Roussos.--(Update in intensive care and
emergency medicine; 15) Includes bibliographical references and index. ISBN 3-540-54297-3
(alk. paper).-ISBN (invalid) 0-387-54297-3 (alk. paper) 1. Respiratory insufficiency.
I. Marini, John J. II. Roussos, Charis, 1942- . III. Series. [DNLM: 1. Respiratory
Insufficiency. 2. Respiratory Therapy-instrumentation. 3. Ventilators, Mechanical.
WI UP66H v. 15 1 WF 140 V465j RC776.R4V45 1991 616.2--dc20 DNLM/DLC
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Contents
Ventilatory Failure: An Overview (D.F.Rochester)
Extrapulmonary and Intrapulmonary Determinants
of Pulmonary Gas Exchange
(R.Rodriguez-Roisin, J.Roca, and J.A.Barbera) . . . .. 18
Control of Ventilation and Response to Loading
(J.Milic-Emili) ................ . . ..... 37
Diagnosing the Adequacy of Neural Stimulation
(J. W.Fitting) ................. . .... 49
Role of Extradiaphragmatic Musculature in Breathing
(M.Decramer) .................... 62
Respiratory Failure: Dynamics of Breathing and Coordination
(B.M.Hagan and R.D.Hubmayr) .............. 75
Assessment of Respiratory Muscle Strength
(W. P. Sexauer, G. J. Criner, and S. G. Kelsen) ........ 97
Ventilatory Muscle Fatigue and Failure
(C.Roussos and S. Lakynthinos) .... 125
Training and the Respiratory Muscles (B. Celli) 153
Pharmacotherapy of the Respiratory Muscle (M.Aubier) 171
Nutrition and Ventilatory Failure (S.K.Ping/eton) . . .. 184
Dynamic Hyperinflation (A. Rossi, G.Po/ese, and G.Brandi) 199
Disorders of the Chest WaIl: Implications for Respiratory
Failure (S.E. Eve/off and F. D. McCool) ........... 219
VI Contents
Pathophysiology of Ventilatory Failure in Patients
with Neuromyopathies (M. Estenne) ..... ...... 240
Risk Factors for Ventilatory Failure in Infants
and Children (C. Gaultier) .......... . . . . 255
Controlled Ventilation: Targets, Hazards and Options
(J.J.Marini) .................. . ... 269
Techniques of Ventilation Using Constant Flow
(A.S.Slutsky) . . . . . . . . . . . . . . . . . . . .... 293
Extracorporeal Carbon Dioxide Removal in ARDS
(L. Gattinoni, L.Brazzi, and A.Pesentij ..... 308
Augmentation of Blood Gas Transfer by Means
of an Intravascular Blood Gas Exchanger (IVOX)
(J. D. Mortensen) ......... . 318
Weaning Assessment (M.J. Tobin) . 347
Proportional Assist Ventilation and Pressure Support
Ventilation: Similarities and Differences (M. Younes) . 361
Pressure Support Ventilation (L.Brochard) . 381
The Role of PEEP in the Mechanically Ventilated
COPD Patient (S. B. Gottfried) . . . . . . . . . . . . . 392
Which Patients Need a Weaning Technique?
(S.Benito, I. Vallverdu, and J.Mancebo) . . . .... 419
Ventilatory Failure: Innovative Support Techniques
(M.A.Branthwaite, M. W.Elliott, and A.K.Simonds) .... 430
Airway Pressure Release Ventilation and BIPA P
(J.J.Rouby) ......................... 444
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . 454
List of Contributors
Aubier, M. Criner, G.J.
Department of Pulmonary Medicine, Division of Pulmonary and Critical
INSERM U 226, 46 rue Henri Care, Temple University Hospital,
Huchard, Paris 75018, France 3401 N Broad Street, Philadelphia,
PA 19140, USA
Barbera, J.A.
Department of Pulmonary Medicine, Decramer, M.
Hospital Clinic, Villarroel 170, Respiratory Division, University
Barcelona 08036, Spain Hospital, Weligerveld 1,
3212 Pellenberg, Belgium
Benito, S.
Department of Critical Care, Hospi Elliott, M. W.
tal de la Santa Creu i Saint Pau, Department of Thoracic Medicine,
Avda Sant Antoni Ma Claret 167, Royal Brompton Hospital, Sydney
Barcelona 08025, Spain Street, London SW3 6NP, United
Kingdom
Brandi, G.
Institute of Human Physiology, Estenne, M.
University of Padova, Padova, Italy Department of Pulmonary Medicine,
Erasme University Hospital,
Branthwaite, M.A. Route de Lennik 808, Brussels 1070,
Department of Thoracic Medicine, Belgium
Royal Brompton Hospital, Sydney
Street, London SW3 6NP, United Eveloff, S.E.
Kingdom Department of Pulmonary Medicine,
Memorial Hospital, Pawtucket,
Brazzi, L. Rhode Island 02860, USA
Department of Intensive Care,
Nuovo Ospedale San Gerardo, Fitting, J. W.
Via G. Donizetti 106, Monza (MI) Division of Pulmonary Medicine,
20052, Italy C.H.U. Vaudois, Lausanne 1011,
Switzerland
Brochard, L.
Department of Intensive Care, Henri Gattinoni, L.
Mondor Hospital, 51 Av du Mare Department of Intensive Care,
chal de Lattre de Tassigny, Nuovo Ospedale San Gerardo,
94010 Creteil, France Via G. Donizetti 106, Monza (MI)
20052, Italy
Celli, B.
Department of Pulmonary Medicine, Gaultier, C.
Veterans Affairs Medical Center, Laboratory of Physiology, A. Be
150 South Huntington Avenue, clere Hospital, 157 rue de la Porte
Boston, MA 02130, USA de Trivaux, Clamart 92141, France
VIII List of Contributors
Gottfried, S. B. Pesenti, A.
Meakins-Christie Laboratories and Department of Intensive Care,
Department of Respiratory and Nuovo Ospedale San Gerardo, Via
Critical Care Medicine, Montreal G. Donizetti 106, Monza (MI) 20052,
General Hospital, 1650 Cedar Ave Italy
nue, Montreal, Quebec, Canada
H3G lA4 Pingleton, S. K.
Division of Pulmonary Medicine,
Hagan, B.M. University of Kansas Medicine Cen
Department of Thoracic and Critical ter, 39th and Rainbow Blvd, Kansas
Care, Mayo Clinic, 200 First Street City, Kansas 66103, USA
SW, Rochester, MN 55905, USA
Polese, G.
Department of Internal Medicine,
Hubmayr, R.D.
University of Verona, Verona 37126,
Department of Thoracic and Critical
Italy
Care, Mayo Clinic, 200 First Street
SW, Rochester, MN 55905, USA Roca, J.
Department of Pulmonary Medicine,
Kelsen, S. G. Hospital Clinic, Villarroel 170,
Division of Pulmonary and Critical Barcelona 08036, Spain
Care, Temple University Hospital,
3401 N Broad Street, Philadelphia, Rochester, D.F.
PA 19140, USA Division of Pulmonary and Critical
Care, University of Virginia, Health
Lakynthinos, S. Sciences Center, Charlottesville,
Department of Critical Care, Evan VA 22908, USA
gelismos Hospital, 45 Ipsilandou
Rodriguez-Roisin, R.
Street, Athens 11521, Greece
Department of Pulmonary Medicine,
Hospital Clinic, Villarroel 170,
McCool, F. D.
Barcelona 08036, Spain
Department of Pulmonary Medicine,
Memorial Hospital, Pawtucket, Rossi, A.
Rhode Island 02860, USA Respiratory Division, Ospedale Civile
Maggiore ULSS 25, Piazzale Ste
Mancebo, J. fani 1, Verona 37126, Italy
Department of Critical Care, Hospi
tal de la Santa Creu i Saint Pau, Rouby, J.J.
Avda Sant Antoni Ma Claret 167, Department of Intensive Care,
Barcelona 08025, Spain G.H.Pitie-Salpetriere, 83 Blvd de
I'Hopital, Paris 75013, France
Marini, J.J.
Roussos, C.
Department of Pulmonary/Critical
Department of Critical Care, Evan
Care, St Paul-Ramsey Medical Cen
gelismos Hospital, 45 Ipsilandou
ter, 640 Jackson Street, St Paul,
Street, Athens 11521, Greece
Minnesota, MN 55101-2595, USA
Sexauer, W. P.
Milic-Emili, J. Division of Pulmonary and Critical
Meakins-Christie Laboratories and Care, Temple University Hospital,
Department of Physiology, McGill
3401 N Broad Street, Philadelphia,
University, 3626 St Urbain Street, PA 19140, USA
Montreal, Quebec H2X 2P2, Canada
Simonds, A.K.
Mortensen, J. D. Department of Thoracic Medicine,
CardioPulmonics Inc, 5060 West Royal Brompton Hospital, Sydney
Amelia Earhart Drive, Salt Lake Street, London SW3 6NP, United
City, Utah 84116, USA Kingdom
List of Contributors IX
Slutsky, A. S. Vallverdu, I.
Division Respiratory Medicine, Department of Critical Care, Hospi
Mount Sinai Hospital, 600 Univer tal de la Santa Creu i Saint Pau,
sity Avenue Room 656A, Toronto, Avda Sant Antoni Ma Claret 167,
Ontario, Canada M6C 3G4 Barcelona 08025, Spain
Tobin, M.J. Younes', M.
Division of Puhfionary and Critical Respiratory Hospital, Health
Care, Hines Veterans Affairs Hospi Sciences Center, 810 Sherbrook
tal, Hines, IL 60142, USA Street Room RS-307, Winnipeg,
Manibota, Canada R3A IR8
Abbreviations
AROS Adult respiratory distress syndrome
ARF Acute respiratory failure
CMV Control mode ventilation
CNEP Continuous negative extrathoracic pressure
CNPV Continuous negative pressure ventilation
CNS Central nervous system
co
Cardiac output
COPO Chronic obstructive pulmonary disease
CPAP Continuous positive airway pressure
CPPV Conventional positive pressure ventilation
CSF Cerebrospinal fluid
CVP Central venous pressure
ECC02R Extracorporeal CO2 removal
EMG Electromyogram
FRC Functional residual capacity
FVC Forced vital capacity
HFJV High frequency jet ventilation
ICU Intensive care unit
IMV Intermittent mandatory ventilation
IPPV Intermittent positive pressure ventilation
IRV Inverse ratio ventilation
MIP Maximal inspiratory pressure
MV Mechanical ventilation
PaC02 Partial pressure of carbon dioxide in arterial blood
Pa02 Partial pressure of oxygen in arterial blood
PAP Pulmonary artery pressure
POi Maximal transdiaphragmatic pressure
PEEP Positive end-expiratory pressure
PEEPi Intrinsic PEEP
PS Pressure support
PTI Pressure time index
XII Abbreviations
PV02 Mixed venous oxygen tension
PVR Pulmonary vascular resistance
RV Residual volume
SIMV Synchronized intermittent mandatory ventilation
TLC Total lung capacity
VAlQ Ventilation-perfusion ratio
VC Vital capacity
VD Dead space
VB Minute ventilation
V0 Oxygen consumption
2
VT Tidal volume
WOB Work of breathing