Basic Concepts and Core Knowledge in Mechanical Ventilation -- Oxygenation and Acid-Base Evaluation -- Review of Arterial Blood Gases -- Evaluating Oxygenation -- Evaluating the Transfer and Uptake of Oxygen from the Alveoli-P(A-a)O[subscript 2], PaO[subscript 2]/P[subscript A]O[subscript 2], and PaCO[subscript 2]/F[subscript 1]O[subscript 2] -- Changes in Alveolar Ventilation Associated with Changes in P[subscript A]O[subscript 2] and P[subscript A]CO[subscript 2] -- Alveolar Ventilation, PaCO[subscript 2], and VCO[subscript 2] -- Changes in pH, PaCO[subscript 2], and Sodium Bicarbonate -- Changes in pH caused by Changes in PaCO[subscript 2] -- Changes in Plasma Bicarbonate Caused by Changes in PaCO[subscript 2] -- Metabolic Changes in Bicarbonate and pH -- Basic Terms and Concepts of Mechanical Ventilation -- Physiological Terms and Concepts Related to Mechanical Ventilation -- Normal Mechanics of Spontaneous Ventilation -- Lung Characteristics -- Time Constants -- Types of Ventilators and Terms Applied to Mechanical Ventilation -- Types of Mechanical Ventilation -- Definition of Pressures in Positive Pressure Ventilation -- How Ventilators Work -- Historical Perspective on Ventilator Classification -- Internal Function -- Power Source or Input Power -- Control Systems and Circuits -- Power Transmission and Conversion System -- How a Breath Is Delivered -- Basic Model of Ventilation in the Lung during Inspiration -- Factors Controlled and Measured by the Ventilator during Inspiration -- Overview of Inspiratory Waveform Control -- Four Phases of a Breath and Phase Variables -- Beginning of Inspiration: The Trigger Variable -- Inspiratory Factors: The Limit Variable -- Termination of the Inspiratory Phase: The Cycling Mechanism (Cycle Variable) -- Types of Breaths -- Expiratory Phase: The Baseline Variable -- Initiating Ventilation -- Establishing the Need for Mechanical Ventilation -- Acute Respiratory Failure -- Patient History and Diagnosis -- Physiological Measurements in Acute Respiratory Failure -- Overview of Criteria for Mechanical Ventilation -- Possible Alternatives to Invasive Ventilation -- Patient Cases -- Selecting the Ventilator and the Mode -- Invasive or Noninvasive Ventilation: Selecting the Patient Interface -- Methods of Noninvasive Support and Appropriate Patient Interfaces -- Full and Partial Ventilatory Support -- Mode of Ventilation and Breath Delivery -- Type of Breath Delivery -- Targeting Volume as the Control Variable -- Targeting Pressure as the Control Variable -- Breath Delivery and Modes of Ventilation -- Bilevel Positive Airway Pressure -- Closed Loop Ventilation -- Less Frequently Used Closed Loop Modes of Ventilation -- Initial Ventilator Settings -- Determining Initial Ventilator Setting during Volume Ventilation -- Initial Settings during Volume Ventilation -- Setting Minute Ventilation -- Tidal Volume and Rate -- Relationship of Tidal Volume, Flow, Total Cycle Time, and Inspiratory to Expiratory Ratio -- Inspiratory Flow and Flow Patterns -- Setting the Minute Ventilation: Special Considerations -- Inspiratory Pause during Volume Ventilation -- Actual Clinical Examples of Ventilator Adjustment -- Determining Initial Ventilator Settings during Pressure Ventilation -- Setting Baseline Pressure-Physiological PEEP -- Determining Tidal Volume Delivery in Pressure Ventilation -- Initial Settings for Pressure Support Ventilation -- Initial Settings for Pressure Control Ventilation -- Initial Settings for Bilevel Positive Airway Pressure Ventilation -- Initial Settings for Dual Control Pressure Ventilation Modes with Volume Targeting -- Final Considerations in Ventilator Setup -- Selection of Additional Parameters and Final Ventilator Setup -- Selection of Fractional Inspired O[subscript 2] -- Sensitivity Setting -- Humidification -- Alarms -- Action during Ventilator Alarm Situations -- Periodic Hyperinflation or Sighing -- Final Considerations in Ventilator Equipment Setup -- Selecting the Appropriate Ventilator -- Evaluation of Ventilator Performance -- Initial Ventilator Settings for Specific Patient Situations -- Chronic Obstructive Pulmonary Disease -- Neuromuscular Disorders -- Asthma -- Closed Head Injury -- Adult Respiratory Distress Syndrome -- Acute Cardiogenic Pulmonary Edema and Congestive Heart Failure -- Monitoring in Mechanical Ventilation -- Initial Assessment of the Mechanically Ventilated Patient -- Documentation of the Patient-Ventilator System -- The First 30 Minutes -- Monitoring Airway Pressures -- Vital Signs, Blood Pressure, and Physical Examination of the Chest -- Management of Endotracheal and Tracheostomy Tube Cuffs -- Monitoring Compliance and Airway Resistance -- Comment Section of the Ventilator Flow Sheet -- Ventilator Graphics -- Relationship of Pressure, Volume, Flow, and Time -- Volume Ventilation with Constant Flow -- Producing Ventilator Graphics -- Calculations -- A Closer Look at the Flow-Time Scalar in VC-CMV -- Changes in the Pressure-Time Curve -- Volume Scalar -- Key Points of Volume Ventilation Graphics -- Pressure Ventilation -- Pressure Ventilation with a Constant Pressure Waveform -- Key Points of Pressure Ventilation Graphics -- Pressure Support Ventilation -- Details of the Pressure-Time Waveform in PSV -- Flow Cycling during PSV -- Automatic Adjustment of the Flow-Cycle Criterion -- Use of PSV with SIMV -- Pressure-Volume Loops -- Components of the P-V Loop -- P-V Loop and WOB -- Troubleshooting a P-V Loop -- Flow-Volume Loops during Mechanical Ventilation -- Components of an F-V Loop with Mandatory Breaths -- Troubleshooting with F-V Loops during Mechanical Ventilation -- Noninvasive Assessment of Respiratory Function -- Noninvasive Measurement of Blood Gases -- Pulse Oximetry -- Capnography and Capnometry -- Transcutaneous Monitoring -- Indirect Calorimetry and Metabolic Measurements -- Overview of Indirect Calorimetry -- Technical Aspects -- Assessment of Respiratory System Mechanics -- Airway Pressure Measurements -- Flow Measurements -- Clinical Applications -- Hemodynamic Monitoring -- Review of Cardiovascular Principles -- Obtaining Hemodynamic Measurements -- Interpretation of Hemodynamic Profiles -- Clinical Applications -- Therapeutic Interventions-Making Appropriate Changes -- Methods to Improve Ventilation and Other Techniques in Patient-Ventilator Management -- Correcting PaCO[subscript 2] Abnormalities -- Common Methods of Changing Ventilation Based on PaCO[subscript 2] and pH -- Metabolic Acidosis and Alkalosis -- Mixed Acid-Base Disturbances -- Increased Physiological Dead Space -- Increased Metabolism and Increased CO[subscript 2] Production -- Intentional latrogenic Hyperventilation -- Permissive Hypercapnia -- Airway Clearance during Mechanical Ventilation -- Secretion Clearance from an Artificial Airway -- Administering Aerosols to Ventilated Patients -- Chest Physiotherapy in Mechanically Ventilated Patients -- Flexible Fiberoptic Bronchoscopy during Mechanical Ventilation -- Additional Patient Management Techniques and Therapies in Ventilated Patients -- Importance of Body Position and Positive Pressure Ventilation -- Ventilator Circuit Changes -- Sputum and Upper Airway Infections -- Fluid Balance -- Psychological and Sleep Status -- Patient Comfort and Safety -- Transport of Mechanically Ventilated Patients within an Acute Care Facility -- Improving Oxygenation and Management of ARDS -- Basics of Oxygenation Using F[subscript 1]O[subscript 2], PEEP studies, and Pressure-Volume Curves for Establishing Optimum PEEP -- Basics of Oxygen Delivery to the Tissues -- Introduction to Positive End-Expiratory Pressure and Continuous Positive Airway Pressure -- PEEP Ranges -- Indications for PEEP/CPAR -- Initiating PEEP Therapy -- Selecting the Appropriate PEEP/CPAP Level (Optimum PEEP) -- Use of Pulmonary Vascular Pressure Monitoring with PEEP -- Pressure-Volume Loops in Setting PEEP -- Contraindications and Physiological Effects of PEEP -- Contraindications for PEEP -- Pulmonary Effects of PEEP -- Transmission of Airway Pressure to Pleural Space -- Uses of PEEP for Problems Other than Acute Lung Injury -- Weaning from PEEP -- Acute Respiratory Distress Syndrome -- Definition and Epidemiology -- Pathophysiology -- Changes in Computed Tomogram with ARDS -- ARDS as an Inflammatory Process -- PEEP and the Vertical Gradient in ARDS -- Lung Protective Strategies: Setting Tidal Volume and Pressures in ARDS -- Long-Term Follow-Up on ARDS -- Recruitment Maneuvers in ARDS -- Illustration of a Recruitment Maneuver -- The Function of Lung Recruitment -- Hazards of Recruitment Maneuvers -- Variability among Patients -- Effects of Chest Wall Compliance on Lung Recruitment -- Patient Evaluation for Lung Recruitment -- Types of Recruitment Maneuvers -- Summary of Recruitment Maneuvers in ARDS -- Patient Cases -- Case Study: Adult Respiratory Distress Syndrome -- Case Study: Congestive Heart Failure -- Frequently Used Pharmacological Agents in Ventilated Patients: Sedatives, Analgesics, and Paralytics -- Sedatives and Analgesics -- Paralytics -- Effects and Complications of Mechanical Ventilation -- Effects of Positive Pressure Ventilation on the Cardiovascular, Cerebral, Renal, and Other Organ Systems -- Effects of Positive Pressure Ventilation on the Heart and Thoracic Vessels -- Adverse Cardiovascular Effects of PPV -- Factors Influencing Cardiovascular Effects of PPV -- Beneficial Effects of PPV on Heart Function in Patients with Left Ventricular Dysfunction -- Minimizing the Physiological Effects and Complications of Mechanical Ventilation -- Effects of Mechanical Ventilation on Intracranial Pressure, Renal Function, Liver Function, and Gastrointestinal Function -- Effects of Mechanical Ventilation on Intracranial Pressure and Cerebral Perfusion -- Renal Effects of Mechanical Ventilation -- Effects of Mechanical Ventilation on Liver and Gastrointestinal Function --

Nutritional Complications during Mechanical Ventilation -- Effects of Positive Pressure Ventilation on the Pulmonary System -- Lung Injury with Mechanical Ventilation -- Effects of Mechanical Ventilation on Gas Distribution and Pulmonary Blood Flow -- Nosocomial Infections and Ventilator-Associated Pneumonia -- Respiratory and Metabolic Acid-Base Status in Mechanical Ventilation -- Air Trapping (Auto-PEEP) -- Hazards of Oxygen Therapy with Mechanical Ventilation -- Increased Work of Breathing -- Ventilator Mechanical and Operational Hazards -- Complications of the Artificial Airway -- Troubleshooting and Problem Solving -- Definition of the Term Problem -- Solving Ventilation Problems -- Protecting the Patient -- Identifying the Patient in Sudden Distress -- Patient-Related Problems -- Ventilator-Related Problems -- Common Alarm Situations -- Use of Graphics to Identify Ventilator Problems -- Unexpected Ventilator Responses -- Noninvasive Positive Pressure Ventilation -- Basic Concepts of Noninvasive Positive Pressure Ventilation -- Noninvasive Ventilation Techniques -- Goals and Indications for NPPV -- Patient Selection Criteria -- Equipment Selection for NPPV -- Setup and Preparation for NPPV -- Monitoring and Adjustment of NPPV -- Complications of NPPV -- Patient Weaning and Discontinuation of NPPV -- Patient Care Team Concerns -- Discontinuation from Ventilation and Long-Term Ventilation -- Discontinuation of and Weaning from Mechanical Ventilation -- Weaning Techniques -- Methods of Titrating Ventilator Support during Weaning -- Closed Loop Modes for Ventilator Discontinuation -- Evidence-Based Weaning -- Evaluation of Clinical Criteria for Weaning -- Pathology of Ventilator Dependence -- Assessment of Readiness for Weaning Using Evaluation Criteria -- Assessment during a Spontaneous Breathing Trial -- Removal of the Artificial Airway -- Factors in Weaning Failure -- SBT Failure -- Nonrespiratory Factors That May Complicate Weaning -- Maintaining Ventilation in Patients with SBT Failure -- Final Recommendations -- Anesthesia and Sedation Strategies and Protocols -- Weaning Protocols -- Role of Tracheostomy in Weaning -- Long-Term Care Facilities for Patients Requiring Prolonged Ventilation -- Clinician Familiarity with Long-Term Care Facilities -- Weaning in Long-Term Ventilation Units -- Ethical Dilemma: Withholding and Withdrawing Ventilatory Support -- Long-Term Ventilation -- Goals of LTMV -- Sites for Ventilator-Dependent Patients -- Patient Selection -- Preparation for Discharge to the Home -- Follow-Up and Evaluation -- Equipment Selection for Patients to Be Ventilated at Home -- Complications of Long-Term Positive Pressure Ventilation -- Alternatives to Invasive Mechanical Ventilation at Home -- Expiratory Muscle Aids and Secretion Clearance -- TTs, Speaking Valves, and Tracheal Buttons -- Ancillary Equipment and Equipment Cleaning for Home Mechanical Ventilation -- Special Applications of Mechanical Ventilation -- Neonatal and Pediatric Mechanical Ventilation -- Recognizing the Need for Mechanical Ventilatory Support -- Continuous Positive Airway Pressure -- Conventional Mechanical Ventilation -- Weaning and Extubation -- High-Frequency Ventilation -- Special Techniques in Ventilatory Support -- Airway Pressure-Release Ventilation -- Other Names -- Advantages of APRV Compared with Conventional Ventilation -- Disadvantages -- Initial Settings for APRV -- Adjusting Ventilation and Oxygenation -- Discontinuing APRV -- High-Frequency Oscillatory Ventilation in the Adult -- Technical Aspects -- Initial Control Settings for HFOV in the Adult -- Indication and Exclusion Criteria for HFOV in the Adult -- Monitoring, Assessment, and Adjustment of HFO -- Adjusting Settings to Maintain ABG Goals -- Returning to Conventional Ventilation -- Heliox Therapy and Mechanical Ventilation -- Gas Flow through the Airways -- Heliox in Avoiding Intubation and during Mechanical Ventilation -- Postextubation Stridor -- Devices for Delivering Heliox in Spontaneously Breathing Patients -- Manufactured Heliox Delivery System -- Heliox and Aerosol Delivery during Mechanical Ventilation -- Heliox with a Mechanical Ventilator -- Heliox and NPPV -- Independent Lung Ventilation -- Ventilator Procedure for ILV -- Thoracoabdominal Aortic Aneurism Repair -- Establishing Safe PEEP and Ventilation with a Slow Flow Inflection Maneuver for Assessment of Lung Characteristics -- Establishing Mechanical Ventilation after TAAA -- Recruitment Maneuvers in Postoperative Patients -- Intrapulmonary Percussive Ventilation -- Equipment -- Administration by Mouthpiece -- Administration through a Ventilator