Physiological basis of ventilatory support:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
New York [u.a.]
Dekker
1998
|
| Schriftenreihe: | Lung biology in health and disease
118 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XXIX, 1436 S. Ill., graph. Darst. |
| ISBN: | 0824798619 |
Internformat
MARC
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Datensatz im Suchindex
| _version_ | 1804126719461818368 |
|---|---|
| adam_text | Introduction Claude Lenfant Hi
Preface v
Contributors ix
Part One PHYSIOLOGY UNDERLYING VENTILATORY SUPPORT
A. Control of Breathing and Respiratory Muscle Function
1. Control of Breathing Relevant to Mechanical Ventilation 1
Magdy Younes and Dimitris Georgopoulos
I. Introduction 1
II. Overview 3
III. Motor System 4
IV. Central Mechanisms 29
V. Afferent Mechanisms 36
References 63
xviii Contents
2. Loaded Breathing and Dyspnea 75
Kieran J. Killian
I. Introduction 75
II. Sensory Consequences of Breathing 76
III. Sensations and Perceptions Associated with the Act of Breathing 76
IV. Psychophysical Measurements 80
V. Loaded Breathing and Psychophysics 89
VI. Relevance to Mechanical Ventilation 92
VII. Summary 97
References 99
3. Muscle Function: Basic Concepts 103
Theodoros Vassilakopoulos, Spyros Zakynthinos, and Charts Roussos
I. Introduction 103
II. Functional Anatomy 104
III. Statics of Breathing 112
IV. Energetics and Blood Flow 118
V. Respiratory Muscle Fatigue 132
VI. What Is the Role of Fatigue in the Patient Who Fails to Wean? 141
References 146
4. Assessment of Drive/Muscle Function 153
RolfD. Hubmayr and Peggy M. Simon
I. Introduction 153
II. Neural Control of Respiration 154
III. Defining Respiratory Motor Output and Drive 155
IV. Techniques Used to Estimate Respiratory Motor Output and Drive
in Patients with Respiratory Failure 155
V. Effects of Ventilator Mode and Settings on Respiratory Drive
and Timing 160
VI. Conclusions 170
References 170
B. Respiratory Mechanics
5. Mechanics of the Lungs and Chest Wall 177
Stephen H. Loring
I. Introduction 177
Contents x[x
II. Respiratory System Mechanics 178
III. Respiratory System Characteristics 184
IV. Chest Wall Mechanics 193
References 205
6. Surfactant and Mechanical Ventilation 209
Alan H. Jobe and Machiko Ikegami
I. Introduction 209
II. Surfactant and Normal Ventilation 209
III. Ventilation of the Surfactant Deficient Lung 212
IV. An Overview of Surfactant Metabolism 215
V. Surfactant Abnormalities in Lung Injury 216
VI. Surfactant and Nonuniform Lung Injury 218
VII. Surfactant Type and Response to Ventilation 219
VIII. Clinical Experiences with Surfactant for ARDS 221
IX. Surfactant and Other Therapies 223
X. Conclusions 224
References 224
7. Assessment of Mechanics 231
Jason H. T. Bates
I. Introduction 231
II. Inverse Modeling and the Lung 232
III. Measurement Issues 233
IV. Methods Based on Quasistatic Single Compartment Models 240
V. Methods Based on Dynamic Single Compartment Models 243
VI. Methods Based on Dynamic Multicompartment Models 248
VII. Summary 255
References 256
8. Work of Breathing During Mechanical Ventilation 261
Catherine S. H. Sassoon and C. Kees Mahutte
I. Introduction 261
II. Mechanical Work of Breathing 262
III. Oxygen Cost of Breathing 289
IV. Pressure Time Product and Pressure Time Index 294
V. Summary 301
References 302
xx Contents
C. Gas Exchange
9. Distributions of Alveolar Ventilation and Pulmonary Blood Flow 311
Josep Roca and Roberto Rodriguez Roisin
I. Introduction 311
II. Pulmonary and Systemic Determinants of O2 and Co2 Exchange 312
III. Spontaneous Versus Mechanical Ventilation 318
IV. Effects of Anesthesia 319
V. Obstructive Airway Diseases 319
VI. Acute Respiratory Distress Syndrome and
Life Threatening Pneumonia 324
VII. Ventilatory Strategy Approaches 328
VIII. Conclusions 335
References 336
10. The Effects of Mechanical Ventilation on Oxygen Delivery
and Oxygen Consumption 345
James A. Russell
I. Introduction 345
II. Oxygen Delivery/Consumption Relationship 346
III. Pathological Dependence of Oxygen Consumption on Oxygen
Delivery: The Evidence 348
IV. Clinical Studies Indicating Pathological Dependence of Vo2
on Do2 in Critically 111 Adults 350
V. Mathematical Coupling of Shared Measurement Error 352
VI. Assessment of Do2 and Vo2 in Critically 111 Patients by
Independent Techniques 356
VII. Randomized Controlled Trials of Supranormal Oxygen Delivery 359
VIII. Effect of Mechanical Ventilation on Oxygen Delivery 361
IX. Effects of Mechanical Ventilation on Oxygen Demand
and Oxygen Consumption 363
X. Recommendations for a Clinical Approach to Management
of Oxygen Delivery and Oxygen Consumption in Critically 111
Ventilated Patients 367
XI. Summary 368
References 369
Part Two CONSEQUENCES OF MECHANICAL VENTILATION
A. Ventilation Related Consequences
Contents xx[
11. Patient Ventilator Interactions: Dyssynchrony and
Imposed Loads 375
Neil R. Maclntyre
I. Introduction 375
II. Determinants and Characteristics of the Spontaneous
Ventilatory Pattern 376
III. Ventilator Tracking of Spontaneous Effort 377
IV. Interactive Ventilator Design Features 378
V. Future Approaches to Improving Patient Ventilator Synchrony 388
References 389
12. Ventilator Induced Lung Injury: Mechanisms and
Clinical Correlates 395
Lorraine N. Tremblay, Arthur S. Slutsky, Didier Dreyfuss,
and Georges Saumon
I. Introduction 395
II. Ventilation Induced Pulmonary Edema and Related Findings 396
III. Effects of Low Lung Volume Ventilation on Lung Injury 412
IV. Possible Mechanisms of Ventilator Induced Lung Injury 417
V. Clinical Relevance 434
VI. Summary 442
References 442
13. Dynamic Hyperinflation 453
John J. Marini
I. Introduction 453
II. Definitions 455
III. Physiological Consequences 464
IV. Measurement of Auto PEEP and Dynamic Hyperinflation 470
V. Implications of Dynamic Hyperinflation for Ventilatory Support 475
References 485
14. Heart Lung Interactions 491
Michael R. Pinsky
I. Introduction 491
II. Hemodynamic Effects of Ventilation 492
III. Hemodynamic Effects of Changes in Lung Volume 498
xxii Contents
IV. Hemodynamic Effects of Changes in Intrathoracic Pressure 503
V. Clinical Trials of Different Forms of Mechanical Ventilation 512
VI. Conclusions 518
References 518
B. Non Ventilation Related Consequences
15. Upper Airway Dysfunction 533
John E. Heffner
I. Introduction 533
II. Techniques for Airway Intubation 534
III. Specific Forms of Upper Airway Dysfunction 545
References 562
16. Conditioning of Inspired Gases 575
Maire P. Shelly
I. Introduction 575
II. Physical Principles 576
III. Anatomy of the Upper Airway 576
IV. Physiology of the Upper Airway 577
V. Pathophysiology of the Upper Airway 581
VI. Equipment 586
VII. Clinical Applications 590
VIII. Future Developments 592
IX. Conclusions 593
References 593
17. Sedation and Paralysis During Mechanical Ventilation 601
Luciano Aguilera, Javier Alonso, Anton Arizaga,
Thomas E. Stewart, and Jesus Vdlar
I. Introduction 601
II. Drug Selection and Monitoring 602
III. Sedative Drugs 603
IV. Neuromuscular Blocking Agents 610
V. Conclusions 616
References 617
Part Three IMPLEMENTING VENTILATORY SUPPORT
A. Initiating Mechanical Ventilation
Contents xxiii
18. Physiological Consequences of Intubation 623
Steven Deem and Michael J. Bishop
I. Introduction 623
II. Innervation of the Airway and Airway Reflexes 623
III. Physiological Responses to Airway Manipulation and
Tracheal Intubation 624
IV. Physical Effects of the Endotracheal Tube 638
References 645
19. Targets During Mechanical Ventilation 655
Keith G. Hickling
I. Introduction 655
II. Pressure and Volume Targets 656
III. Permissive Hypercapnia 661
IV. The Effect of Hypercapnia on Oxygenation 670
V. Buffering of Acidosis 681
VI. Targets for Paco2 and pH 683
VII. Practical Implementation of Permissive Hypercapnia 684
VIII. Weaning During Permissive Hypercapnia 686
IX. Tolerance of Hypoxemia 687
X. Outcome with Pressure Limited Strategies 692
References 695
20. Monitoring of the Mechanically Ventilated Patient 709
Robert Shapiro and Robert M. Kacmarek
I. Introduction 709
II. Gas Exchange 710
III. Mechanics 732
IV. Breathing Workload 754
V. Neuromuscular Function 762
References 771
B. Modes of Ventilatory Support
21. Full Ventilatory Support 783
Theodore W. Marcy
I. Introduction 783
II. Physiology and Terminology of Full Ventilatory Support Modes 784
xxiv Contents
III. Specific Applications 794
IV. Disadvantages of Full Support Modes 803
V. Conclusions 808
References 808
22. Partial Ventilatory Support 817
Pierre Aslanian and Laurent J. Brochard
I. Features Common to Different Modes 817
II. Goals of Partial Ventilatory Support 822
III. Current Modes 825
IV. Other Methods 832
References 839
23. PEEP and CPAP in Severe Airflow Obstruction 847
Andrea Rossi, Lorenzo Appendini, and Marco V. Ranieri
I. Introduction 847
II. Dynamic Pulmonary Hyperinflation 848
III. Intrinsic PEEP 849
IV. Expiratory Flow Limitation 855
V. Rationale for Application of PEEP and CPAP in Patients with
Severe Airflow Obstruction 858
VI. Application of PEEP During CMV 859
VII. Application of PEEP During Assisted Ventilation 859
VIII. Application of CPAP 861
IX. Application of PEEP and CPAP in Severe Acute Asthma 864
X. Best PEEP/CPAP in Severe Airflow Obstruction 865
XI. Conclusions 866
References 867
24. Positive End Expiratory Pressure in Acute Respiratory Failure:
Pathophysiology and Practical Guidelines 873
Peter M. Suter and Francois Lemaire
I. Introduction 873
II. Historical Review 874
III. Rationale for the Use of PEEP 875
IV. Mechanism Underlying Improved Systemic Oxygenation by the
Application of PEEP 876
Contents xxv
V. (Minimal) PEEP to Decrease Stretch Injury 882
References 885
25. High Frequency Ventilation: Principles and Practice 889
Sergio P. Ribeiro, Lorraine N. Tremblay, and Arthur S. Slutsky
I. Introduction 889
II. Historical Overview 890
III. Modes of High Frequency Ventilation 891
IV. Principles of Gas Transport 897
V. HFV and Acute Lung Injury 903
VI. Other Applications of HFV 907
VII. Complications and Limitations 910
VIII. Conclusions 911
References 912
26. Noninvasive Positive Pressure Ventilation in Patients with
Acute Respiratory Failure 921
G. Umberto Meduri
I. Introduction 921
II. Hypercapnic Respiratory Failure 926
III. Hypoxemic Respiratory Failure 942
IV. Patients with Advanced Disease 956
V. Postextubation Respiratory Failure and Difficult Weaning 958
VI. Methodology 960
VII. Advantages of NPPV 973
VIII. Disadvantages of NPPV 976
IX. Education and Implementation 978
X. Cost Effectiveness 978
XI. Conclusions 979
References 980
C. Adjunctive Methods and Approac hes
27. Extracorporeal Support of Gas Exchange 997
Antonio Pesenti. Michela Bambino, and Luciano Gattinoni
1. Introduction 997
II. Adult Respiratory Distress Syndrome 997
III. Rationale of Artificial Organ Support for Respiratory Insufficiency 998
IV. Extracorporeal Support: A Historical Overview 999
xxviii Comm
34. Barotrauma, Volutrauma, and the Ventilation of Acute
Lung Injury H
Marcelo B. P. Amato and John J. Marini
I. Clinical Forms and Consequences of Lung Injury 1187
II. Implications of Thoracic Mechanics 1221
References 1232
35. Special Problems in Mechanical Ventilation 1247
Robert W. Taylor and R. Phillip Dellinger
I. Introduction 1247
II. Mechanical Ventilation of Patients with Bronchopleural Fistula 1248
III. Independent Lung Ventilation 1253
IV. Mechanical Ventilation of Congestive Heart Failure 1261
V. Mechanical Ventilation in Acute Myocardial Ischemia 1265
VI. Mechanical Ventilation of Acute Neuromuscular Disease and
Related Disorders 1268
VII. Mechanical Ventilation in Patients with Traumatic Brain Injury 1271
References 1272
36. Discontinuation of Ventilatory Support 1283
Amal Jubran and Martin J. Tobin
I. Introduction 1283
II. Pathophysiological Determinants of Weaning Outcome 1284
III. Predicting Weaning Outcome 1294
IV. Methods of Discontinuing Mechanical Ventilation 1300
V Extubation 1306
VI. Conclusions 1308
VII. References 1308
37. Neonatal and Pediatric Ventilation: Physiological and
Clinical Perspectives 1315
Alison B. Froese
I. Introduction 1315
II. Considerations Peculiar to Neonates 1316
III. Therapeutic Themes: The 1970s 1319
IV. Emergence of Novel Therapies: The 1980s 1321
V. Emergence of Pathophysiologically Based Strategies of Ventilator
Support in the 1990s 1328
Contents xxix
VI. Selection of Ventilator Frequency 1333
VII. Interactions Among Therapies 1335
VIII. Current Trends in Conventional Ventilation 1339
IX. Pediatric Experience 1341
X. Machine Factors 1341
XL What Further Information Is Needed? 1342
XII. Revising Our Continuum of Ventilatory Care 1346
References 1350
38. Clinical Trial Issues in Mechanical Ventilation 1359
Alan H. Morris and Deborah J. Cook
I. Introduction 1359
II. Empiricism/Observation/Rules of Evidence: How to
Draw Inferences of High Confidence (Strength)/Meta Analysis 1360
III. Problems with ARDS Research 1368
IV Level of Inquiry 1373
V. Clinical Laboratory Protocols 1375
VI. Ethics 1380
VII. Summary 1383
References 1384
Index 1399
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| spelling | Physiological basis of ventilatory support ed. by John J. Marini ... New York [u.a.] Dekker 1998 XXIX, 1436 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Lung biology in health and disease 118 Beademing gtt Fysiologische aspecten gtt Respirators (Medical equipment) Physiologie (DE-588)4045981-0 gnd rswk-swf Künstliche Beatmung (DE-588)4033439-9 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Künstliche Beatmung (DE-588)4033439-9 s Physiologie (DE-588)4045981-0 s DE-604 Marini, John J. Sonstige oth Lung biology in health and disease 118 (DE-604)BV000008326 118 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008203103&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Physiological basis of ventilatory support Lung biology in health and disease Beademing gtt Fysiologische aspecten gtt Respirators (Medical equipment) Physiologie (DE-588)4045981-0 gnd Künstliche Beatmung (DE-588)4033439-9 gnd |
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| title | Physiological basis of ventilatory support |
| title_auth | Physiological basis of ventilatory support |
| title_exact_search | Physiological basis of ventilatory support |
| title_full | Physiological basis of ventilatory support ed. by John J. Marini ... |
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| title_short | Physiological basis of ventilatory support |
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