| Series Introduction | p. iii |
| Preface | p. v |
| Contributors | p. ix |
| Demographics And Epidemiology | |
| Epidemiology of Acute Respiratory Failure | p. 1 |
| Introduction | p. 1 |
| What Is Acute Respiratory Failure? | p. 2 |
| Type 1 Acute Respiratory Failure | p. 3 |
| Type 2 Acute Respiratory Failure | p. 4 |
| Indications for Intubation with or Without Assisted Ventilation | p. 6 |
| Etiology of Acute Respiratory Failure | p. 7 |
| Acute Respiratory Distress Syndrome | p. 14 |
| Chronic Obstructive Pulmonary Disease | p. 21 |
| Summary | p. 28 |
| References | p. 28 |
| Evolution of the Modern Mechanical Ventilator | p. 37 |
| Evolution of the Concepts Underlying Mechanical Ventilation | p. 37 |
| Devices Used for Resuscitation | p. 38 |
| Devices Used for Ventilatory Support of Healthy Lungs | p. 40 |
| Devices Designed for Respiratory Support of Diseased Lungs--The Modern Era | p. 41 |
| Mechanical Ventilation--Current Status | p. 46 |
| Mechanical Ventilation--Challenges for the Future | p. 47 |
| Conclusion | p. 48 |
| References | p. 49 |
| Utilization of Mechanical Ventilation for Critical Care: An International Perspective | p. 53 |
| Introduction | p. 53 |
| The Use of Mechanical Ventilation | p. 54 |
| Duration of Mechanical Ventilation: Effect on Morbidity and Mortality | p. 56 |
| Demographic Characteristics of Patients Who Undergo Mechanical Ventilation | p. 62 |
| Airway Management | p. 67 |
| Ventilator Modes and Settings | p. 68 |
| Weaning Techniques | p. 71 |
| The Economic Impact of Mechanical Ventilation | p. 72 |
| Conclusion | p. 73 |
| References | p. 74 |
| Costs Associated with Mechanical Ventilation | p. 79 |
| Introduction | p. 79 |
| Economic Terminology | p. 81 |
| Cost of Mechanical Ventilation in Critical Care | p. 85 |
| Effects of Specific Diagnoses on Costs and Outcomes of Mechanical Ventilation | p. 89 |
| Economics and Outcomes of Patients Transferred Out of the ICU to Less Acute Settings | p. 91 |
| Outcome Prediction and the Decision to Use Mechanical Ventilation | p. 95 |
| Noninvasive Positive Pressure Ventilation as a Cost-Saving Technique | p. 95 |
| Ancillary Approaches to Decrease Cost for Mechanical Ventilation of ICU Patients | p. 98 |
| Organizational Issues and Optimal Management of Mechanical Ventilation | p. 101 |
| Conclusion | p. 105 |
| References | p. 106 |
| Strategies for Optimal Utilization of Mechanical Ventilation in Critical Care | |
| Mechanical Ventilation: Protocol-Driven Strategies | p. 111 |
| Introduction | p. 111 |
| Why Use Protocols and Guidelines? | p. 112 |
| How Do Protocols and Guidelines Work? | p. 114 |
| How Do You Successfully Develop and Implement a Protocol or Guideline? | p. 116 |
| Using Formal Multidisciplinary Teams for the Management of Mechanical Ventilation | p. 119 |
| Protocol-Guided Management of Mechanical Ventilation | p. 121 |
| Protocol Management of Innovative Mechanical Ventilation Strategies | p. 126 |
| Summary | p. 128 |
| References | p. 129 |
| Noninvasive Ventilation: A Strategy to Improve Outcomes and Resource Utilization in Critical Care | p. 137 |
| Introduction | p. 137 |
| Rationale | p. 138 |
| General Considerations for Patient Selection in the Acute Setting | p. 138 |
| Appropriate Recipients of NPPV | p. 140 |
| Practical Application of NPPV in the Critical Care Setting | p. 144 |
| Effects of NPPV on Patient Outcomes | p. 156 |
| Summary and Conclusions | p. 165 |
| References | p. 166 |
| New Modes of Ventilation | p. 171 |
| Introduction | p. 171 |
| The Ventilator Trigger | p. 172 |
| Pressure Ventilation | p. 181 |
| Dual Control Modes | p. 199 |
| AutoMode | p. 208 |
| Mandatory Minute Ventilation | p. 208 |
| Adaptive Support Ventilation | p. 209 |
| Conclusions | p. 211 |
| References | p. 211 |
| Closed Loop Mechanical Ventilation | p. 223 |
| Introduction | p. 223 |
| What Is Closed Loop Ventilation? | p. 224 |
| Computer Decision Support Systems Versus True Closed Loops | p. 224 |
| How Does Closed Loop Ventilation Work? | p. 225 |
| Inputs | p. 225 |
| Gas Exchange | p. 225 |
| Mechanics | p. 226 |
| Patient Respiratory Drive (P[subscript 0.1]) | p. 233 |
| Inputs Summary | p. 234 |
| Outputs | p. 234 |
| Respiratory Rate and Tidal Volume | p. 234 |
| I:E Ratio | p. 237 |
| Weaning | p. 237 |
| Future Directions | p. 238 |
| References | p. 239 |
| Treatment of Agitation and Its Comorbidities in the Intensive Care Unit | p. 243 |
| Agitation in the ICU | p. 243 |
| Delirium in the ICU | p. 245 |
| Brain Failure and Delirium | p. 246 |
| Clinical Presentations of Brain Failure | p. 247 |
| Comorbidities of Brain Failure and Delirium | p. 248 |
| Rational Treatment of Agitation and Its Comorbidities | p. 252 |
| Treatment of Anxiety and Discomfort | p. 260 |
| Selecting the Most Efficacious Drug Therapy | p. 263 |
| Continuous Infusions in the ICU: Current Experience | p. 264 |
| Analgesia and Sedation Combinations: Role of Fentanyl | p. 268 |
| Management of Agitation in Organ System Failure | p. 270 |
| Clearance of Commonly Used ICU Sedatives and Analgesics | p. 272 |
| Role of Sedative-Reversal Agents in the ICU | p. 273 |
| Life-Threatening Agitation in the ICU | p. 274 |
| Anxiolysis During Withdrawal of Life Support | p. 275 |
| Palliating the Dying Process During Respiratory Failure | p. 276 |
| References | p. 277 |
| Optimal Airway Management in Ventilated Patients | p. 285 |
| Introduction | p. 285 |
| Artificial Airway Placement | p. 286 |
| Artificial Airway Maintenance | p. 301 |
| Artificial Airway Discontinuation | p. 313 |
| Overall Summary | p. 315 |
| References | p. 317 |
| Ventilatory Strategies for Specific Causes of Respiratory Failure | |
| Ventilator Management Strategies for Acute Asthma | p. 327 |
| Introduction | p. 327 |
| Pathophysiology | p. 328 |
| Preventing Intubation | p. 330 |
| Intubation | p. 332 |
| Postintubation Hypotension | p. 334 |
| Initial Ventilator Settings | p. 334 |
| Assessing Dynamic Hyperinflation | p. 338 |
| Ventilator Adjustments | p. 341 |
| Sedation and Paralysis | p. 342 |
| Bronchodilator Delivery During Mechanical Ventilation | p. 344 |
| Adjunctive Therapies During Mechanical Ventilation | p. 345 |
| Summary and Conclusion | p. 346 |
| References | p. 346 |
| Ventilator Management Strategies for COPD Patients | p. 353 |
| Introduction | p. 353 |
| Pathophysiology of Ventilatory Impairment in COPD | p. 354 |
| Noninvasive Ventilation for Exacerbations of COPD | p. 363 |
| Invasive Mechanical Ventilation for Acute Respiratory Failure in COPD | p. 374 |
| Summary and Conclusions | p. 384 |
| References | p. 385 |
| Strategies of Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome | p. 393 |
| Introduction | p. 393 |
| Background | p. 394 |
| Ventilator-Induced Lung Injury | p. 394 |
| Alveolar Recruitment | p. 398 |
| Modes of Mechanical Ventilation in ARDS | p. 405 |
| Ventilation Strategies in ARDS | p. 408 |
| Alternative Modes of Mechanical Ventilation in ARDS | p. 416 |
| Adjuvants to Mechanical Ventilation in ARDS | p. 429 |
| Summary and Conclusions | p. 432 |
| References | p. 433 |
| Noninvasive Positive-Pressure Ventilation in Acute Respiratory Failure Not Related to Chronic Obstructive Pulmonary Disease | p. 451 |
| Introduction | p. 451 |
| Hypercapnic Respiratory Failure | p. 453 |
| Hypoxemic Respiratory Failure | p. 462 |
| Patients with Advanced Disease | p. 480 |
| Postextubation Respiratory Failure and Difficult Weaning | p. 481 |
| Conclusions | p. 483 |
| References | p. 483 |
| Strategies to Facilitate the Weaning Process | |
| Strategies for Predicting Successful Weaning from Mechanical Ventilation | p. 499 |
| Introduction | p. 499 |
| Why Obtain Weaning Predictors? | p. 500 |
| Pathophysiology of Weaning Failure | p. 501 |
| Reintubation | p. 504 |
| General Principles in the Evaluation of Weaning Predictors | p. 506 |
| Specific Weaning Predictors | p. 509 |
| Summary | p. 521 |
| References | p. 522 |
| Optimizing the Efficiency of Weaning from Mechanical Ventilation | p. 531 |
| Introduction | p. 531 |
| Prospective Randomized Controlled Trials--What Have We Learned? | p. 532 |
| Daily Screening Techniques | p. 536 |
| Spontaneous Breathing Trials | p. 538 |
| Prediction Models | p. 541 |
| Large-Scale Implementation of a Protocol | p. 544 |
| Outcomes of Mechanically Ventilated Patients | p. 547 |
| Further Discussion of Implementation of Therapist-Driven Protocol | p. 548 |
| Compliance with the Protocol | p. 549 |
| Other Barriers to Protocol Compliance | p. 551 |
| Additional Caveats | p. 552 |
| Patient Subgroups | p. 553 |
| Reintubations: Distinguishing Causes | p. 563 |
| Conclusions | p. 566 |
| References | p. 570 |
| Noninvasive Ventilation to Facilitate Weaning from Mechanical Ventilation | p. 579 |
| A Word Lesson | p. 579 |
| Weaning Failure and Prolonged Ventilation | p. 580 |
| Avoiding Intubation | p. 583 |
| Reducing the Duration of Mechanical Ventilation | p. 585 |
| Weaning Through Noninvasive Ventilation | p. 586 |
| Future Applications | p. 597 |
| Conclusions | p. 600 |
| References | p. 601 |
| Strategies to Minimize Complications of Mechanical Ventilation | |
| Strategies to Avoid Ventilator-Induced Lung Injury | p. 611 |
| Introduction | p. 611 |
| Evidence for VILI | p. 611 |
| Strategies to Prevent VILI | p. 619 |
| Clinical Studies | p. 625 |
| Conclusion | p. 628 |
| References | p. 629 |
| Strategies for Diagnosing, Managing, and Avoiding Ventilator-Associated Pneumonia | p. 635 |
| Introduction | p. 635 |
| Epidemiology | p. 636 |
| Pathogenesis | p. 637 |
| Diagnosis | p. 638 |
| Treatment | p. 641 |
| Risk Factors and Prevention | p. 642 |
| Summary | p. 646 |
| References | p. 646 |
| Effects of Mechanical Ventilation on Heart-Lung Interactions | p. 655 |
| Introduction | p. 655 |
| Spontaneous Ventilation Is Exercise | p. 656 |
| Inspiration Increases Lung Volume | p. 657 |
| Relationship Between Airway Pressure, Intrathoracic Pressure, and Lung Volume | p. 663 |
| Hemodynamic Effects of Changes in Intrathoracic Pressure | p. 668 |
| Patient-Specific Heart--Lung Interactions | p. 678 |
| Summary and Conclusions | p. 681 |
| References | p. 682 |
| Outcomes of Mechanical Ventilation | |
| Extubation Failure: Predictions and Consequences | p. 693 |
| Introduction | p. 693 |
| Prevalence of Extubation Failure | p. 694 |
| Pathophysiology of Extubation Failure | p. 702 |
| Extubation Outcome | p. 708 |
| Prediction of Extubation Outcome | p. 714 |
| Treatment and Prevention of Extubation Failure | p. 727 |
| Unplanned Extubation Failure | p. 729 |
| Summary | p. 731 |
| References | p. 732 |
| "Pulling the Plug": Ethical Considerations in the Withholding and Withdrawal of Mechanical Ventilation | p. 743 |
| Introduction | p. 743 |
| Case Law | p. 744 |
| Limiting Agreement | p. 746 |
| Terminal Weaning | p. 748 |
| Pain Control | p. 749 |
| Summary and Conclusions | p. 752 |
| References | p. 752 |
| Author Index | p. 755 |
| Subject Index | p. 813 |
| Table of Contents provided by Syndetics. All Rights Reserved. |
