Respiratory Care: Principles and Practice

Normal Values
Title Page
Copyright Page
Brief Contents
Contents
Preface
Features
About the Editors
Contributing Authors
Reviewers
Chapter 1 History and Physical Examination
Introduction
Creating a Therapeutic Climate
Components of the Health History
Chief Complaint
History of Present Illness
Occupational and Environmental History
Geographic Exposure
Activities of Daily Living
Smoking History
Cough and Sputum Production
Family History
Medical History
Review of Systems
Vital Signs
Techniques of Assessment
Inspection
Palpation
Percussion
Auscultation
Physical Examination of the Lungs and Thorax
Inspection
Palpation
Percussion
Auscultation
Signs of Respiratory Distress
Assessment of Other Body Systems
The Heart and Blood Vessels
The Neurologic System
Key Points
Suggested Reading
Chapter 2 Respiratory Monitoring
Introduction
Pulse Oximetry
Approaches to Deal with Errors Caused by Motion and Low Perfusion
Pulse Oximetry to Measure Hemoglobin, Carboxyhemoglobin, and Methemoglobin
Use of the Plethysmographic Waveform
Capnography
Time-Based Capnography
End-Tidal PCO2
Volume-Based Capnography
Transcutaneous Monitoring
Respiratory Rate and Pattern
Brain Tissue PO2
Near-Infrared Spectroscopy
Key Points
References
Chapter 3 Hemodynamic Monitoring
Introduction
Cardiac Rate and Rhythm
Arterial Blood Pressure
Respiratory Variation in Pulse Amplitude
Noninvasive Cardiac Output
Central Venous Pressure Monitoring
Pulmonary Artery Catheters
Catheter Setup
Pressure Waveforms
Pitfalls in Interpreting Waveforms
Cardiac Output Measurement
Continuous Oximetric Monitoring
Vascular Resistance
Clinical Use of Hemodynamic Measurements
Key Points
References
Chapter 4 Arterial Blood Gas Sampling, Analysis, and Interpretation
Introduction
Blood Gas Analyzers
pH Electrode
PCO2 Electrode
PO2 Electrode
Oximeter
Point-of-Care Testing
Blood Gas Sampling and Analysis
Sites of Arterial Puncture
Allen Test
Radial Arterial Puncture
Punctures of Other Arterial Sites
Radial Arterial Cannulation
Venous Blood Gases
Capillary Blood Gases
Preanalytic Errors
Sample Analysis
Calibration
Quality Control and Proficiency Testing
Temperature Adjustment
Physiology of Acid–Base Balance
Concept of pH
Buffer Solutions
Henderson-Hasselbalch Equation
Clinical Application of the Henderson-Hasselbalch Equation
Base Excess
Anion Gap
Strong Ion Difference
Albumin-Corrected Anion Gap
Regulation of pH
Erythrocytes and Acid–Base Control
The Lungs and Acid–Base Control
The Kidneys and Acid–Base Control
Acid–Base Disorders
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Arterial Blood Gas Interpretation
Normal Arterial Blood Gas Values
Seven-Step Approach to ABG Interpretation
Case Studies
Case 1. Acute Respiratory Acidosis
Case 2. Partially Compensated Metabolic Acidosis
Case 3. Partially Compensated Respiratory Acidosis
Key Points
References
Chapter 5 Blood Chemistries and Hematology
Introduction
Serum Electrolytes
Body Water
Sodium
Potassium
Chloride
Total Serum Carbon Dioxide
Unmeasured Anions
Calcium
Magnesium
Phosphorus
Lactate
Serum Chemistries Associated with Renal Function
Blood Urea Nitrogen
Creatinine
Serum Enzyme Activity
Cardiac Enzymes and Proteins
Cardiac Enzymes
Troponins
Brain Natriuretic Peptide
Miscellaneous Serum Chemistries
C-Reactive Protein
Bilirubin
Proteins
Glucose
Procalcitonin
Coagulation Tests
Prothrombin Time
Activated Partial Thromboplastin Time
Thrombin Time
Hematology
Hemoglobin and Hematocrit
Platelets
Total and Differential Leukocyte Count
Laboratory Standards and Quality Control
Key Points
References
Chapter 6 Cardiac Assessment
Introduction
Evaluation of Ventricular Function
Case 1. Congestive Heart Failure
Left Ventricular Dysfunction
Case 2. Right Ventricular Failure
Right Ventricular Function
Valvular Function
Case 3. Valvular Disease
Evaluation of Valvular Function
Coronary Artery Disease
Case 4. Coronary Artery Disease
Evaluation of the Coronary Circulation
Specific Tests to Assess Coronary Circulation
Anatomic Tests
Arrhythmias
Case 5. Cardiac Arrhythmia
ECG in Pulmonary Disease
Refractory Hypoxemia
Case 6. Intracardiac Shunt
Bubble Echocardiogram
Key Points
References
Appendix 6-1
Locations for Chest Electrodes
Lead I
Lead II
Lead III
Lead MCL1 (Modified Chest Lead)
Dysrhythmia Recognition
Normal Sinus Rhythm (NSR)
Sinus Bradycardia
Sinus Tachycardia
Sinus Arrhythmia
Premature Atrial Contractions (PACs)
Supraventricular Tachycardia
Atrial Flutter
Atrial Fibrillation
Premature Junctional Contractions (PJCs)
Accelerated Junctional Rhythm
Junctional Tachycardia
Premature Ventricular Contractions (PVCs)
Ventricular Escape Rhythm (Idioventricular Rhythm [IVR])
Accelerated Idioventricular Rhythm (AIVR)
Ventricular Tachycardia (Monomorphic VT)
Torsades de Pointes
Ventricular Fibrillation
Asystole (Ventricular Asystole, Ventricular Standstill)
First-Degree AV Block
Second-Degree AV Block, Type I (Wenckebach, Mobitz I)
Second-Degree AV Block, Type II (Mobitz II)
Second-Degree AV Block, 2:1 Conduction
Complete (Third-Degree) AV Block
Chapter 7 Imaging the Thorax
Introduction
Density and Contrast
The Normal Chest Radiograph
Technical Factors
Examination of the Chest Radiograph
Abnormalities Seen on Chest Radiographs
Chronic Obstructive Pulmonary Disease
Pneumonia
Atelectasis
Left Heart Failure
Pneumothorax and Air Leaks
Pleural Effusion
Evaluation of Tubes and Catheters
Pulmonary Embolism
Acute Respiratory Distress Syndrome
Chest Trauma
Computed Tomography
Ultrasonography
Magnetic Resonance Imaging
Positron Emission Tomography
Electrical Impedance Tomography
Key Points
References
Chapter 8 Pulmonary Function Testing
Introduction
Goals of Pulmonary Function Testing
Infection Control
Spirometry
Equipment
Pretest Procedures
Spirometry Tests
Forced Vital Capacity
Flow-Volume Loops and Volume-Time Graphs
Slow Vital Capacity
Maximum Voluntary Ventilation
Quality Assurance of Spirometry Testing
Bronchodilator Testing
Spirometry Interpretation
Lung Volumes and Capacities
Measurement of Lung Volumes
Nitrogen Washout Test
Helium Dilution Test
Body Plethysmography Test
Interpretation of Lung Volumes
Diffusing Capacity
Interpretation of DLCO
Specialized Pulmonary Function Tests
Bronchial Challenge Tests
Methacholine Challenge
Mannitol Challenge
Exercise Challenge
Airways Resistance
Airways Resistance via Body Plethysmography
Impulse Oscillometry (Forced Oscillation Technique)
Respiratory Muscle Strength
Exhaled Nitric Oxide
Single Breath Nitrogen Washout (SBN2)
Exercise Laryngoscopy
Key Points
References
Chapter 9 Interventional Pulmonary Procedures
Introduction
Diagnostic Bronchoscopy
Overview of Bronchoscopy
The Flexible Bronchoscope
Flexible Fiberoptic Bronchoscopy
Patient Selection
Asthma and Bronchospasm
Cardiovascular Risk
Head Trauma and Elevated Intracranial Pressure
Hypoxemia and High Oxygen Requirement
Anticoagulant and Antiplatelet Therapy
Thrombocytopenia
Uremia and Renal Dysfunction
Patient Preparation
Informed Consent
Procedure Risks and Complications
Minimizing Complications
Postprocedure Care and Education
Patient Sedation
Flexible Fiberoptic Bronchoscopy Techniques
Airway Examination
Bronchoalveolar Lavage
Bronchoscopic Washing
Bronchoscopic Brushing
Endobronchial Biopsy
Transbronchial Biopsy
Transbronchial Needle Aspiration
Complications of Bronchoscopy
Pneumothorax
Bleeding Complications
Indications for Bronchoscopy
Acute Lung Collapse, Atelectasis, and Secretion Management
Hemoptysis
Cough
Suspected Malignancy
Infection
Suspected Foreign Body Aspiration
Interstitial Lung Disease
Lung Transplant
Trauma
Therapeutic Bronchoscopy
Rigid Bronchoscopy
Indications
Equipment
Insertion
Anesthesia and Ventilation
Therapeutic Procedures
Airway Stenting
Silicone Stents
Self-Expanding Metallic Stents
Hybrid Stents
Efficacy and Complications of Stent Placement
Pleural Disease
Indications for Thoracentesis
Thoracentesis Procedure
Interpretation of Results
Management of Recurrent Pleural Effusions
Endobronchial Valves
Key Points
References
Chapter 10 Polysomnography
Introduction
Normal Sleep and Sleep Stages
Polysomnography Components
Electroencephalography
Electrooculography
Electromyography
Respiratory Measurement
Scoring Criteria
Sleep Stages
Major Body Movements
Sleep-Disordered Breathing
Arousals
Cardiac Rules
Periodic Limb Movements of Sleep
Polysomnography Report
Key Points
References
Chapter 11 Nutrition Assessment and Support
Introduction
Effects of Nutrition on Respiratory Function and Critical Illness
Minute Ventilation
Muscle Weakness
Surfactant Production
Obesity
Immune Function
Hypoalbuminemia
Stress Response to Critical Illness
Refeeding Syndrome
Acute and Chronic Inflammation
Nutrition Assessment
Calculation and Measurement of Energy Requirements
Equations Versus Measurements
Calorimetry
Indirect Calorimetry
Modified Weir Equation Method
Caloric Equivalent Method
Fick Method
Protein Requirements
Nutritional Support Guidelines
Nutrition Delivery
Nutritional Support in Mechanically Ventilated Patients
Nutritional Support in Chronic Respiratory Disease
Key Points
References
Chapter 12 Cardiopulmonary Exercise Assessment
Introduction
Normal Cardiopulmonary Response to Exercise
Oxygen Consumption and Carbon Dioxide Production
Ventilatory Responses
Gas Exchange Responses to Exercise
Cardiovascular Responses to Exercise
Oxygen Delivery
Oxygen Extraction
Incremental Exercise Testing
Symptom-Limited Work Rate
Symptoms at Maximal Exercise
Oxygen Consumption and Carbon Dioxide Production
Exercise Ventilation
Arterial Blood Gas Measurements
Ratio of Dead Space to Tidal Volume
Cardiovascular Assessment
Interpreting the Results of Incremental Cardiopulmonary Exercise Testing
Timed Walk Tests
Indications for Cardiopulmonary Exercise Testing
Safety Issues
Key Points
References
Chapter 13 Therapeutic Gases: Manufacture, Storage, and Delivery
Introduction
Chemical and Physical Properties of Therapeutic Gases
Flammability
Life Support
Atmospheric Concentration (by Volume)
Atmospheric Pressure
Viscosity
Density
Relative Density
Boiling Point
Critical Temperature
Critical Pressure
Triple Point
Solubility in Water
Physical State in Cylinder
Air
Therapeutic Uses
Manufacture
Cylinders
Piped Air Systems
Portable Compressors
Oxygen
Physical Characteristics
Support of Combustion
Manufacture and Distribution of Oxygen
Photosynthesis
Isolating Metallic Oxides
Electrolysis of Water
Fractional Distillation of Liquefied Air
Molecular Filtration
Distribution
Carbon Dioxide
Physical Characteristics
Therapeutic Uses
Manufacture and Distribution
Helium
Physical Characteristics
Therapeutic Uses
Manufacture and Distribution
Nitric Oxide
Physical Characteristics
Therapeutic Uses
Manufacture and Distribution
Nitrogen
Physical Characteristics
Therapeutic Uses
Manufacture and Distribution
Storage and Distribution of Medical Gases
Medical Gas Cylinders
Cylinder Markings
Cylinder Testing
Cylinder Color-Coding and Labeling
Cylinder Valves
Safe Storage and Handling of Cylinders
Regulators
Safety-Indexed Connection Systems
American Standard Safety System
Pin Index Safety System
Diameter Index Safety System
Calculating Duration of Flow from a Gas Cylinder
Central Medical Gas Distribution
Systems for Gas Storage and Distribution
Liquid Oxygen Systems for Home and Transport
Alternating Supply Systems
Gas Piping Systems
Valves
Zone Valves
Gauges and Alarms
Station Outlets
Central Compressed Medical Air Distribution
Key Points
References
Chapter 14 Therapeutic Gases: Management and Administration
Introduction
The Rationale for Supplemental Oxygen
Indications for Oxygen Therapy
Limitations of Supplemental Oxygen
Complications and Hazards of Oxygen Therapy
Oxygen Toxicity
Hyperoxemia
Nitrogen Washout Atelectasis
Oxygen-Induced Hypoventilation
Retinopathy of Prematurity
Closure of the Ductus Arteriosus
Support of Combustion
Dosage Regulation and Administration Devices
Flow Restrictor
Bourdon Gauge Flow Meters
Thorpe Tube Flow Meters
Oxygen Administration Devices
Low-Flow (Variable-Performance) Devices
High-Flow (Fixed-Performance) Devices
Oxygen Enclosures
Hyperbaric Oxygen Therapy
Monitoring the Physiologic Effects of Oxygen
Blood Gases and Oximetry
Oxygen Analysis
Clinical Application of Oxygen Therapy
Helium–Oxygen Therapy
Carbon Dioxide Therapy
Nitric Oxide Therapy
Key Points
References
Chapter 15 Humidity and Aerosol Therapy
Introduction
Humidity
Normal Heat and Moisture Exchange
Goals of Humidity Therapy
Devices Used for Humidification
Active Humidifiers
Passive Humidifiers
Bland Aerosol Therapy
Humidification to Tracheostomy
Device Selection for Humidity Therapy
Aerosol Drug Administration
Basic Concepts of Aerosol Therapy
Aerosol Deposition, Targeting, and Translocation
Factors Affecting Drug Dose Distribution
Aerosol Generators
Jet Nebulizers
Mesh Nebulizers
Soft Mist Inhaler
Ultrasonic Nebulizers
Pressurized Metered-Dose Inhalers
Spacers and Valved Holding Chambers
Dry Powder Inhalers
Aerosol Delivery During Invasive Mechanical Ventilation
Aerosol Delivery During Noninvasive Ventilation
Aerosol Delivery by Tracheostomy
Aerosol Delivery by High-Flow Nasal Cannula
Selection of an Aerosol Delivery Device
Aerosol Delivery for Systemic Disease
Key Points
References
Chapter 16 Airway Clearance and Lung Expansion Therapy
Introduction
Normal Mechanisms of Mucociliary Transport
Airway Clearance
Deep Breathing and Coughing
Forced Expiratory Technique
Manually Assisted Cough
Active Cycle of Breathing
Autogenic Drainage
Mechanical Insufflation–Exsufflation
Aerosol Therapy
Conventional Chest Physiotherapy
Positive Expiratory Pressure
Oscillatory (or Vibratory) Positive Expiratory Pressure
High-Frequency Chest Wall Compression
Intrapulmonary Percussive Ventilation
High-Frequency Chest Wall Oscillation
Exercise
Selection of Airway Clearance Technique
Sputum Collection
Induced Sputum
Tracheal Aspirate
Bronchoscopy
Mini-bronchoalveolar Lavage
Transtracheal Aspiration
Lung Expansion Therapy
Continuous Positive Airway Pressure
Incentive Spirometry
Intermittent Positive Pressure Breathing
Key Points
References
Chapter 17 Airway Management
Introduction
Oropharyngeal Airways
Types
Insertion
Complications
Nasopharyngeal Airways
Insertion
Complications
Airway Management Training
Anatomy of the Upper Airway and Airway Assessment
Indications for Endotracheal Intubation
Initial Approach to Airway Management
Airway Assessment
Endotracheal Tubes
Preoxygenation
Endotracheal Intubation: Preparation and Performance
Procedure of Endotracheal Intubation
Technique for Orotracheal Intubation
Technique for Nasotracheal Intubation
Drugs to Facilitate Intubation
Complications of Endotracheal Intubation
Securing the Endotracheal Tube
The Difficult Airway: Assessment and Strategy
Extraglottic Airways
Gum Elastic Bougie
Video Laryngoscopy Devices
Cricothyrotomy
Extubation
Tracheostomy
Advantages and Disadvantages of Tracheostomy
Timing of Tracheostomy
Open Tracheostomy
Percutaneous Dilational Tracheostomy
Metal Tracheostomy Tubes
Current Construction of Tracheostomy Tubes
Uncuffed Tracheostomy Tubes
Cuffed Tracheostomy Tubes
Dual-Cannula Tracheostomy Tube
Subglottic Suction Port
Foam Cuff Tracheostomy Tubes
Tight-to-Shaft Cuff Tracheostomy Tubes
Sleep Apnea Tracheostomy Tubes
Adjustable Flange Tracheostomy Tubes
Fenestrated Tracheostomy Tubes
Talking Tracheostomy Tubes
Speaking Valves
Speaking in Ventilator-Dependent Patients with a Tracheostomy Tube
Eating with a Tracheostomy
Trach and Stoma Buttons
Securing Tracheostomy Tubes
Changing the Tracheostomy Tube
Decannulation
Accidental Decannulation
Airway Cuff Concerns
Airway Clearance
Open Suction
Closed Suction
Subglottic Suction
Saline Instillation
Key Points
References
Chapter 18 Cardiopulmonary Resuscitation
Introduction
Cardiopulmonary Resuscitation
Incidence and Epidemiology
History, Evolution, and Milestones
Current Guideline Developments
Chain of Survival
Risk Factors
Basic Life Support
The Initial Steps
CABD Sequence
Circulation
Choking Relief for Adults and Children (1 Year and Older)
Relief for a Choking Child
Choking Infant Relief
Difficult Bag-Mask Ventilation
Cardiopulmonary Resuscitation for a Child
Cardiopulmonary Resuscitation for an Infant
Summary of Basic Life Support
Advanced Cardiovascular Life Support
Airway Management
Post–Cardiac Arrest Care
Stabilization of Acute Coronary Care Patients
Summary of Advanced Cardiovascular Life Support
Ethical Concerns
Key Points
References
Chapter 19 Mechanical Ventilators: Classification and Principles of Operation
Introduction
Basic Concepts
Power Inputs
Pressure, Volume, and Flow Outputs
Patient Circuits
Ventilator Alarm Systems
Ventilator Displays
Alphanumeric Values
Trends
Waveforms and Loops
Understanding Ventilator Technology
Ten Fundamental Maxims
Taxonomy of Mechanical Ventilation
Comparing Modes of Mechanical Ventilation
Key Points
References
Chapter 20 Mechanical Ventilation
Introduction
The Equation of Motion
Indications for Mechanical Ventilation
Complications of Mechanical Ventilation
Ventilator-Induced Lung Injury
Oxygen Toxicity
Ventilator-Associated Pneumonia
Auto-PEEP
Hemodynamic Effects of Positive Pressure Ventilation
Ventilator Settings
Volume Control Versus Pressure Control
Ventilator Modes
Breath Triggering
Tidal Volume
Respiratory Rate
Inspiratory Time
Inspiratory Flow Pattern
Positive End-Expiratory Pressure
Mean Airway Pressure
Recruitment Maneuvers
Inspired Oxygen Concentration
Sigh
Alarms
Circuit
Humidification
Monitoring the Mechanically Ventilated Patient
Physical Assessment
Blood Gas Measurements
Plateau Pressure and Auto-PEEP
Hemodynamics
Patient–Ventilator Interaction
Sedation
Choosing Ventilator Settings for Different Forms of Respiratory Failure
Acute Respiratory Distress Syndrome
Obstructive Lung Disease
Neuromuscular Disease
Intraoperative and Postoperative Mechanical Ventilation
Ventilatory Support Trade-Offs
Liberation from Mechanical Ventilation
Respiratory Muscles
Assessing Readiness for Liberation
Approaches to Liberation
Recognition of a Failed Spontaneous Breathing Trial
Causes of a Failed Spontaneous Breathing Trial
Ventilator Discontinuation Protocols
Sedation
ABCDEF Bundle
Key Points
References
Chapter 21 Noninvasive Respiratory Support
Introduction
High-Flow Nasal Cannula
Mechanism of Action
HFNC Prongs
Clinical Indications
Interfaces for CPAP and NIV
Continuous Positive Airway Pressure
Acute Care Applications
CPAP for Obstructive Sleep Apnea
Noninvasive Positive Pressure Ventilation
Acute Care Applications
Chronic Applications
Ventilators for Noninvasive Positive Pressure Ventilation
Clinical Application
Sequential Use of NIV and HFNC
Negative Pressure Ventilation, Rocking Beds, and Pneumobelts
Key Points
References
Chapter 22 Neonatal and Pediatric Respiratory Care
Introduction
Neonatal Assessment
Apgar Score
Gestational Age
Physical Assessment
Noninvasive and Hemodynamic Monitoring
Oxygen Therapy
Indications
Hazards
Delivery Devices
Mechanical Ventilation
Manual Ventilation
Airway Management
Endotracheal Intubation
Suctioning
Nasal Continuous Positive Airway Pressure
Noninvasive Positive Pressure Ventilation
Conventional Infant and Pediatric Ventilation
Indications
Infant Ventilators
Pressure Limit and Tidal Volume
Respiratory Rate
Mode
Inspiratory Trigger and Expiratory Cycle
Inspiratory Time
Positive End-Expiratory Pressure
Humidification
Hazards and Complications
Liberation
High-Frequency Ventilation
Classification
Gas Transport Theories
Patient Selection
High-Frequency Ventilators
Management Strategies
Complications
Adjuncts to Neonatal and Pediatric Mechanical Ventilation
Surfactant Administration
Inhaled Nitric Oxide
Key Points
References
Chapter 23 Extracorporeal Life Support for Respiratory Failure
Introduction
History of ECMO Use in Respiratory Failure
ECMO Basics
Indications and Contraindications
ECMO Management
Monitoring
Anticoagulation
Sedation
Fluid Administration
Mechanical Ventilation
Blood Transfusion
Timing of ECMO Decannulation
ECMO Outcomes
Complications
Bleeding
Neurologic Injury
Infection
Vascular Injury and Thrombosis
Technological Advancements
Key Points
References
Chapter 24 Pulmonary Rehabilitation
Introduction
Mechanisms of Functional Deterioration in Patients with Chronic Lung Disease
Program Structure
Intensive Programs
Maintenance Programs
Perioperative Programs
The Process of Pulmonary Rehabilitation
Patient Selection
Patient Assessment
Education
Exercise
Other Interventions
Outcomes from a Pulmonary Rehabilitation Program
Reimbursement Issues
Future Directions
Key Points
References
Chapter 25 Home Respiratory Care
Introduction
Home Care Services
Goals of Home Care
The Medicare Program
Medicaid Coverage for Home Medical Equipment
Requirements for Home Medical Equipment Companies
Accreditation of Home Medical Equipment Companies
Equipment Management Services Versus Clinical Respiratory Services
Orders for Clinical Respiratory Services
The Respiratory Therapist as Home Care Provider
Requirements for the Respiratory Therapist Providing Home Respiratory Care
The Initial Home Visit
Bag Technique
Home Environment Evaluation
Environmental Issues for Patients on Home Oxygen Therapy
Environmental Issues for Patients on Home Mechanical Ventilation
Working with Local Emergency Medical Services and Firefighters
The Physician Order
Long-Term Oxygen Therapy
Evidence Supporting Home Oxygen Therapy
Key Issues in O2 Therapy
Methods of O2 Delivery
Home O2 Delivery Devices
O2-Conserving Devices
Diagnostic Systems for Long-Term O2 Therapy
O2 Delivery Accessory Items
Patient Interface
Selection of an O2 Delivery Device for the Home
Newer Home Therapies
Mouthpiece Ventilation
Proportional Open Ventilation
Home Ventilation
Diagnoses and Indications for Home Mechanical Ventilation
Discharge Planning for the Patient Going Home with a Mechanical Ventilator
Evolution of Positive Pressure Home Mechanical Ventilators
Backup Ventilator and Emergency Supplies
Setting Ventilator Alarms
Safety Tips
Caregiver Burden
Ventilator User’s Quality of Life
Key Points
References
Chapter 26 Disaster Management
Introduction
History
The Threat
Traumatic Injury
Chemical Weapons
Epidemics and Febrile Respiratory Illness
Planning for Mass-Casualty Respiratory Failure
Staffing
Personal Protective Equipment
Oxygen
Disposables
Ventilators
Ventilator Performance Characteristics
Ventilators for Mass-Casualty Respiratory Failure
Automatic Resuscitators
EMS Portable Ventilators
Pneumatically Powered Portable Ventilators
Electrically Powered Portable Ventilators
Critical Care Ventilators
Noninvasive Ventilators
Triage
Key Points
References
Chapter 27 Respiratory Care of the Elderly
Introduction
The Demography of Aging
Terms Associated with Aging
Aging Pulmonary Anatomy and Physiology
Geriatric Patient Assessment
Physical Assessment
Comprehensive Geriatric Assessment
Atypical Disease Presentation
Pneumonia
Myocardial Infarction
Congestive Heart Failure
Tuberculosis
Depression
Geriatric Pharmacotherapy
Medication Safety
Adverse Drug Events
Medication Undertreatment and Overtreatment
Drug Expenditures
Communicating with Older Adults
Effective Communication
The Angry Patient
The Verbally Abusive Patient
The Confused Patient
Pulmonary Disease After Age 65 Years
Obstructive Disease
Restrictive Disease
Healthy Aging Strategies
Health-Damaging Behaviors
Role of the Respiratory Therapist in Caring for the Elderly
Key Points
References
Appendix 27-1 Resources for Screening Tests in the Elderly
Chapter 28 Patient Safety
Introduction
Patient Safety
High-Reliability Organizations
Culture of Safety
High Risk/High Reliability
Safe Harbor
Teamwork
Commitment
Robust Process Improvement
Root-Cause Analysis
Incident Reports
Safety Initiatives and Respiratory Care Applications
Rapid Response Teams
Safe Medication Practices
Reports and Handoffs
Need for Conversation at Handoffs
Clinical Alarms and Equipment
Universal Protocol
Discharge Education and Planning
Hospital-Acquired Conditions/Infections
Ventilator-Associated Events
Respiratory Protocols and Patient Safety
Management of Medical Information
Rationale
Elements of a Patient Medical Record
Medical Record Documentation Standards
Essentials for Respiratory Care Documentation
Orders
Electronic Medical or Health Records
Legal Implications of the Record
Patient Confidentiality Issues
Key Points
References
Chapter 29 Principles of Disease Management
Introduction
Trends and Directions in Healthcare Delivery
Terms and Concepts Associated with Disease Management
Care Management
Component Management
Demand Management
Case Management
Disease Management
Population Health Management
Integrated Care
Chronic Care Model
Forces Driving Disease Management
Cost and Changing Patterns of Disease
Determinants of Health
Social Determinants of Health
The Epidemiology Triangle
History and Evolution of Disease Management
Pharmaceutical Industry
Managed Care Organizations
Population Health Alliance
Core Components of Disease Management
Key Components of the Chronic Care Model
Goals of Disease Management
Basic Principles of Disease Management
Natural Course, Causes, and Cost Drivers of Disease
Diagnosis and Treatment Based on Disease Rather Than Reimbursement Patterns
Patient Education and Adherence Programs for Chronic Disease Management
Management of Treatment Across the Full Continuum of Care
Funding for the Most Powerful Interventions
Diseases Targeted by Disease Management Programs
Development and Implementation of a Disease Management Program
The Ellrodt and Colleagues Model
FAST Approach: Lamb and Zazworsky Model
Kongstvedt Model
Chronic Care Model or Integrated Care
Respiratory Protocols
The Future of Disease Management
Respiratory Therapists as Disease Managers
Key Points
References
Chapter 30 Patient Education
Introduction
The Rationale for Patient Education
Self-Management and Self-Empowerment
Forces Affecting the Patient Education Movement
Role of the Respiratory Therapist
Terms Associated with Patient Education
Client Education, Consumer Education, and Patient Education
Illness/Wellness Continuum
Clinical Practice Guidelines
The Critical Role of Communication in Patient Education
Multidimensional Communication
Transactional Communication
The Process of Communication
Factors Affecting Communication
Physical Appearance and Status
Skills of the Sender
Skills of the Receiver
Questioning Techniques
Teaching and Learning Aspects of Patient Education
Goals in Patient Education
Process of Patient Education
Overview of the ASSURE Model
Overview of the APIE Model
Assessment
Planning
Implementation
Evaluation
Examples of Patient Education Programs
Asthma Education
Pulmonary Rehabilitation
Tobacco Cessation
Key Points
References
Chapter 31 Infection Control Principles
Introduction
Transmission of Infection
Strategies for Infection Control
Regulatory Agencies
Cleaning, Disinfection, and Sterilization
Cleaning
Disinfection
Sterilization
Equipment Surveillance and Monitoring
Precautions
Standard Precautions
Hand Hygiene
Personal Protective Equipment
Patient Placement
Transmission-Based Precautions
Healthcare-Associated Infections Related to Respiratory Care Equipment
Ventilator-Related Issues
Nebulizers and Aerosol Delivery Devices
Spirometers and Pulmonary Function Testing Equipment
Key Points
References
Chapter 32 Asthma
Introduction
Epidemiology
Pathophysiology
Airway Inflammation
Airway Hyperresponsiveness
Airway Obstruction
Pathogenesis
Risk Factors
Asthma Phenotypes
Allergic Asthma
Pollution and Environmental Irritant-Related Asthma
Emotion-Associated Asthma
Food and Drug Additive–Related Asthma
Viruses
Nocturnal Asthma
Exercise-Induced Asthma
Occupational Asthma
Disease Severity Classification
Intermittent Asthma
Mild Persistent Asthma
Moderate Persistent Asthma
Severe Persistent Asthma
Assessing Control of Asthma
Asthma Exacerbation
Status Asthmaticus
Objective Measurements
Spirometry
Lung Volumes and Airways Resistance
Peak Flow Meters
Exhaled Nitric Oxide
Pharmacologic Therapy
Controller Medications
Quick-Relief Medications
Aerosol Therapy
Nebulizers
Continuous Aerosolized Bronchodilators
Pressurized Metered-Dose Inhalers
Spacers and Valved Holding Chambers
Respimat
Dry Powder Inhalers
Adjunctive Treatments
Heliox
Magnesium Sulfate
Noninvasive Ventilation
Invasive Ventilation
Education
Case Studies
Case 1. Ambulatory Asthma Management
Case 2. Life-Threatening Asthma Management
Key Points
References
Chapter 33 Chronic Obstructive Pulmonary Disease
Introduction
Definitions
Diagnosis, Symptoms, and GOLD Stages
Etiology of Chronic Obstructive Pulmonary Disease
Pathophysiology of Chronic Obstructive Pulmonary Disease
Outpatient Care of Stable Chronic Obstructive Pulmonary Disease
Smoking Cessation
Drug Therapy
Long-Term Oxygen Therapy
Vaccinations
Ventilatory Support
Management of Sleep-Related Abnormalities
Pulmonary Rehabilitation
Airway Clearance Therapy
Surgery and Bronchoscopic Interventions
Giant Bullectomy
Lung Volume Reduction Surgery
Lung Transplantation
Bronchoscopic Interventions
Managing Exacerbations
Readmissions
Palliative and End-of-Life Care
Case Studies
Case 1. Initial Presentation of Chronic Obstructive Pulmonary Disease
Case 2. Exacerbation of Chronic Obstructive Pulmonary Disease
Key Points
References
Chapter 34 Interstitial Lung Disease
Introduction
Pathophysiology
Classification
Clinical Presentation and Diagnostic Evaluation
Symptoms and Signs
Pulmonary Function Testing
Radiographic Findings
Laboratory Findings
Bronchoscopy
Surgical Lung Biopsy
Pathology
Prognosis
Management
Specific Interstitial Lung Diseases
Idiopathic Pulmonary Fibrosis
Sarcoidosis
Interstitial Lung Disease with Connective Tissue Disease
Eosinophilic Granuloma
Respiratory Bronchiolitis Interstitial Lung Disease
Pulmonary Alveolar Proteinosis
Drug-Induced Interstitial Lung Disease
Acute Interstitial Lung Disease
Key Points
References
Chapter 35 Pulmonary Vascular Disease
Introduction
Pathophysiology
Normal Pulmonary Vascular Physiology
Pulmonary Vascular Pathophysiology
Pathophysiology of Acute Pulmonary Embolism
Epidemiology
Diagnosis
Acute Pulmonary Embolism
Chronic Pulmonary Hypertension and Right Heart Failure
Management of Selected Pulmonary Vascular Diseases
Acute Pulmonary Embolism
Chronic Cor Pulmonale
Pulmonary Arterial Hypertension
Other Classes of Pulmonary Hypertension
Case Studies
Case 1. Acute Right Ventricular Failure
Case 2. Idiopathic Pulmonary Arterial Hypertension
Key Points
References
Chapter 36 Pneumonia
Introduction
Definition and Classification of Pneumonia
Community-Acquired Pneumonia
Etiology
Gram-Positive Bacteria
Gram-Negative Bacteria
Atypical Organisms
Diagnostic Workup
Risk Stratification
Therapy
Complications of Community-Acquired Pneumonia
Prevention
Aspiration and Anaerobic Pneumonia
Actinomycosis
Nosocomial Pneumonia
Hospital-Acquired Pneumonia
Ventilator-Associated Pneumonia
Pathogenesis of VAP
Diagnosis of VAP
Ventilator-Associated Events
Microbiology
Treatment
Prevention of VAP
Viral Pneumonia
Influenza Virus
Other Viral Pneumonias
Mycobacterial Pneumonia
Tuberculosis
Nontuberculous Mycobacteria
Fungal Pneumonia
Aspergillosis
Zygomycosis
Histoplasmosis
Blastomycosis
Cryptococcosis
Coccidioidomycosis
Candidiasis
Pneumonia in Immunocompromised Patients
Clinical Considerations
Radiologic Considerations
Diagnostic Considerations
Treatment Considerations
Pneumonia and HIV/AIDS
Bacterial Pneumonia
Pneumocystis Pneumonia
MTB and HIV Infection
AIDS-Defining Pneumonias
Case Studies
Case 1. Community-Acquired Pneumonia
Case 2. Pneumonia in an Immunocompromised Host
Key Points
References
Chapter 37 Cystic Fibrosis
Introduction
History
Pathogenesis
Genetics of Cystic Fibrosis
CFTR Functions and Host Defense
Diagnosis
Immunoreactive Trypsinogen Testing
Sweat Testing
CFTR Mutational Analysis
Nasal Epithelial Potential Difference
Extrapulmonary Manifestations
Upper Respiratory Tract
Exocrine and Endocrine Pancreas
Gastrointestinal Tract
Hepatobiliary System
Reproductive Tract
Sweat Glands
Respiratory Manifestations
Symptoms
Chest Radiography
Pulmonary Function
Respiratory Microbiology
Infection Control Recommendations
Major Respiratory Complications
Hemoptysis
Pneumothorax
Respiratory Failure
Standard Therapy of Lung Disease
Maintenance Therapy
Exacerbations
Lung Transplantation
Key Points
References
Chapter 38 Acute Respiratory Distress Syndrome
Introduction
Definition
Incidence
Etiology
Clinical Manifestations
Pathobiology
Management
High-Flow Nasal Cannula
Mechanical Ventilation
Pharmacologic Agents
Patient Position
Fluid Management
Extracorporeal Membrane Oxygenation
Outcomes
Prevention
Key Points
References
Chapter 39 Postoperative Respiratory Care
Introduction
Preoperative Assessment and Management
Age
Smoking History
Preexisting Lung Disease
Heart Disease
Obesity
General Health Status
Surgery Grades and ASA Status Classification
Patient Education
Preoperative Testing
Electrocardiogram
Chest Radiograph
Arterial Blood Gas Measurements
Pulmonary Function Tests
Other Lab Tests
Intraoperative Risk Factors
Postoperative Respiratory Failure: Assessment and Management
Hypoxemia
Hypercapnia
Nutrition
Pain Management
Patient Temperature
Muscle Strength
Lung Expansion
Atelectasis
Etiology and Risk Factors
Clinical Manifestations and Diagnostic Findings
Management
Pulmonary Emboli and Pulmonary Thromboembolic Disease
Etiology and Risk Factors
Clinical Manifestations and Diagnostic Findings
Management
Pneumonia
Etiology and Risk Factors
Clinical Manifestations and Diagnostic Findings
Management
Mechanical Ventilation for Respiratory Failure
Key Points
References
Chapter 40 Heart Failure
Introduction
Definition
Epidemiology
Etiology
Cardiac Physiology
Cellular Biology and Biochemistry of Cardiac Function
Cardiac Pump Function
Determinants of Ventricular Function
Preload
Afterload
Contractility
Pathophysiology of Heart Failure
Mechanisms
Classification
Adaptive Mechanisms
Pathophysiology of Pulmonary Edema
Heart–Lung Interactions
Changes in Intrathoracic Pressure
Changes in Lung Volume
Changes in Pulmonary Vascular Resistance
Mechanical Effects of Lung Expansion
Abdominal Pressure Changes
Ventricular Interdependence
Clinical Aspects of Heart Failure
Symptoms
Functional Classification
Physical Examination
Radiography
Measurement and Monitoring of Heart Function
Electrocardiography
Echocardiography
Exercise Stress Test
Radionucleotide Imaging
Coronary Angiography
Computed Tomographic Angiography
Hemodynamic Monitoring
Treatment for Chronic Heart Failure
Nonpharmacotherapy
Pharmacotherapy
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers
Beta Blockers
Diuretics
Aldosterone Antagonists
Hydralazine and Nitrates
Digoxin
Percutaneous Coronary Intervention
Surgical Treatments
Treatment for Acute Heart Failure
Pharmacologic Therapy
Tailored Therapy
Mechanical Circulatory Support
Acute Myocardial Infarction
Ventilatory Support of the Patient with Heart Failure
Noninvasive Ventilation
Invasive Mechanical Ventilation
Cardiac Effects of Mechanical Ventilation
Discontinuing Mechanical Ventilation
Chronic Noninvasive Ventilation in Sleep-Disordered Breathing
Case Studies
Case 1. Ischemic Congestive Heart Failure
Case 2. Acute Valve Insufficiency
Case 3. Diastolic Dysfunction from Hypertension
Case 4. Chronic Congestive Heart Failure from Cardiomyopathy of Coronary Artery Disease
Case 5. Coronary Bypass Surgery
Key Points
References
Chapter 41 Trauma
Introduction
The Primary and Secondary Surveys
Thoracic Trauma
Airway and Breathing Injuries
Laryngotracheal Injuries
Pneumothorax
Circulation Injuries
Hypovolemic Shock
Hemothorax
Cardiac Tamponade
Injuries Encountered During the Secondary Survey
Pulmonary Contusion
Blunt Cardiac Injury
Aortic Injury
Diaphragmatic Injury
Esophageal Injury
Chest Wall Injury
Head Trauma
Intracranial Physiology
Types of Intracranial Lesions
Subdural Hematoma
Primary Survey Issues of Head Injury
Hypoxia
Hyperventilation
Hypotension
Deficits
Secondary Survey Issues of Head Injury
Treatment of Head Injuries
Ventilator Strategies in Trauma Patients
Key Points
References
Chapter 42 Burn and Inhalation Injury
Introduction
Burn Injury
Phases of Burn Care
Burn Coverage
Types of Grafts
Estimating Burn Size
Inhalation Injury
Physiology of Inhalation Injury
Diagnosis of Inhalation Injury
Management of Inhalation Injury
Acute Upper Airway Obstruction
Bronchospasm
Small Airways Obstruction
Pulmonary Infection
Respiratory Failure
Carbon Monoxide Exposure
Hydrogen Cyanide Poisoning
Case Studies
Case 1. Minor Burn with Smoke Inhalation
Case 2. Second- and Third-Degree Burns (70% TBSA) with Severe Inhalation Injury
Key Points
References
Chapter 43 Sepsis
Introduction
Pathogenesis
Recognition
Treatment
Implications for Respiratory Care
Key Points
References
Chapter 44 Neuromuscular Dysfunction
Introduction
Overview
Pathophysiology of Neuromuscular Disease on Respiratory Function
Control of Breathing
Respiratory Muscle Function
Lung and Chest Wall Mechanics
Gas Exchange Abnormalities
Sleep and Neuromuscular Disease
Upper Airway Function
Evaluation of Respiratory Function in Patients with Neuromuscular Disease
Clinical History
Physical Examination
Arterial Blood Gas Measurements
Pulmonary Function Tests
Radiographic Assessment
Assessment of Respiratory Muscle Function
Maximum Mouth Pressures
Maximum Voluntary Ventilation
Transdiaphragmatic Pressure Measurement
Upper Motor Neuron Disorders
Stroke
Spinal Cord Injury
Parkinson Disease
Multiple Sclerosis
Lower Motor Neuron Disorders
Amyotrophic Lateral Sclerosis
Poliomyelitis and Postpoliomyelitis Syndrome
Disorders of the Peripheral Nerves
Phrenic Nerve Injury
Guillain-Barré Syndrome
Critical Illness Polyneuropathy and Neuromyopathy
Disorders of the Neuromuscular Junction
Myasthenia Gravis
Lambert-Eaton Syndrome
Botulism
Inherited Myopathies
Duchenne and Becker Muscular Dystrophies
Myotonic Dystrophy
Acid Maltase Deficiency
Facioscapulohumeral Muscular Dystrophy
Limb-Girdle Muscular Dystrophy
Mitochondrial Myopathy
Acquired Inflammatory Myopathies
Systemic Lupus Erythematosus
Steroid Myopathy
Treatment of Neuromuscular Dysfunction
Respiratory Muscle Training
Assisted Coughing
Glossopharyngeal Assistance
Mechanical Ventilation
Diaphragmatic Pacing
Key Points
References
Chapter 45 Sleep-Disordered Breathing
Introduction
Descriptions and Common Terms
Types of Sleep-Disordered Breathing
Prevalence
Screening for Sleep-Disordered Breathing
Obstructive Sleep Apnea
Pathogenesis
Clinical Features
Complications of Obstructive Sleep Apnea
Diagnosis of Obstructive Sleep Apnea
Treatment of Obstructive Sleep Apnea
Mortality Associated with Obstructive Sleep Apnea
Central Sleep Apnea
Cheyne-Stokes Breathing
High-Altitude Periodic Breathing
Obesity Hypoventilation Syndrome
Restless Legs Syndrome
Prevalence
Treatment of RLS
Key Points
References
Chapter 46 Perioperative Management of Lung Transplant Recipients
Introduction
Lung Transplant History
Disease States for Transplantation
Transplant Recipient Criteria
Lung Allocation Score
Donor Evaluation and Selection
Donor Management
Surgical Procedure
Postoperative Management
Key Points
References
Chapter 47 Lung Cancer
Introduction
Epidemiology
Demographics
Etiology and Risk Factors
Classification
Screening
Case Study: Lung Cancer Screening
Solitary Pulmonary Nodule
Diagnosis and Staging
Signs of Metastasis
Workup
Tests Used to Diagnose and Stage Lung Cancer
Staging
Prognosis
Case Study: Early-Stage Lung Cancer
Treatment
Chemotherapy (Systemic Therapy)
Radiation Therapy
Targeted Therapies
Surgery
Complications
Palliative and End-of-Life Care
Palliative Care
Symptom Control in End-of-Life Care
Case Study: Metastatic Lung Cancer
Key Points
References
Chapter 48 Neonatal and Pediatric Respiratory Disorders
Introduction
Apnea of Prematurity
Pathophysiology and Etiology
Clinical Manifestations
Diagnosis
Management
Complications and Outcomes
Respiratory Distress Syndrome
Pathophysiology and Etiology
Clinical Manifestations
Diagnosis
Management
Complications and Outcomes
Bronchopulmonary Dysplasia and Chronic Lung Disease
Pathophysiology and Etiology
Clinical Manifestations and Diagnosis
Management
Complications and Outcomes
Transient Tachypnea of the Newborn
Pathophysiology and Etiology
Clinical Manifestations
Diagnosis
Management
Complications and Outcomes
Pneumonia in the Neonate
Pathophysiology and Etiology
Clinical Manifestations
Diagnosis
Management
Complications and Outcomes
Meconium Aspiration Syndrome
Pathophysiology and Etiology
Clinical Manifestations
Diagnosis
Management
Complications and Outcomes
Persistent Pulmonary Hypertension of the Newborn
Pathophysiology
Etiology
Clinical Manifestations
Diagnosis
Management
Complications and Outcomes
Congenital Diaphragmatic Hernia
Pathophysiology and Etiology
Clinical Manifestations
Diagnosis
Management
Complications and Outcomes
Congenital Pulmonary Anomalies
Pulmonary Hypoplasia
Pulmonary Aplasia
Pulmonary Agenesis
Congenital Pulmonary Airway Malformation
Bronchogenic Cyst
Pulmonary Sequestration
Air Leak Syndrome
Pneumothorax
Pulmonary Interstitial Emphysema
Pneumomediastinum
Pneumopericardium
Retinopathy of Prematurity
Pathophysiology
Clinical Manifestations and Diagnosis
Management
Complications and Outcomes
Bronchiolitis
Pathophysiology
Etiology
Clinical Manifestations
Diagnosis
Management
Complications and Outcomes
Laryngotracheobronchitis
Pathophysiology and Etiology
Clinical Manifestations
Diagnosis
Management
Complications and Outcomes
Epiglottitis
Pathophysiology and Etiology
Clinical Manifestations
Diagnosis
Management
Complications and Outcomes
Key Points
References
Chapter 49 Respiratory Anatomy
Introduction
Growth and Development of the Respiratory System
Prenatal Development
Postnatal Lung Development
Gross Anatomy of the Respiratory System
Upper Respiratory Tract
Lower Respiratory Tract
Anatomy of the Thorax
Bony Thorax
Respiratory Muscles
Lungs
Pleurae
Microanatomy of the Respiratory System
Mucociliary Clearance
Airway and Vascular Smooth Muscle
Mast Cell, Macrophages, and Dendritic Cells
Alveolar Cells
Interstitial Space
Key Points
Suggested Reading
Chapter 50 Ventilation and Oxygenation
Introduction
Ventilation
Dead Space Ventilation
Alveolar Ventilation
Physiologic Mechanisms of Hypercapnia
Carbon Dioxide Transport
Carbon Dioxide Dissociation Curve
The Alveolar Gas Equation
Diffusion
Fick’s Law
Ventilation-Perfusion
Mismatch
Assessment of Oxygenation
Shunt
Mechanisms of Hypoxemia
Oxygen Transport
The Oxyhemoglobin Dissociation Curve
O2 Content in the Blood
O2 Delivery and O2 Consumption
Tissue Hypoxia
Mixed Venous O2
Key Points
References
Chapter 51 Respiratory Mechanics
Introduction
Airways Resistance
Compliance
Pleural Pressure Gradient
The Chest Wall
Causes of Uneven Ventilation
Respiratory Mechanics During Mechanical Ventilation
Equation of Motion
Alveolar Pressure
Esophageal Pressure
Intra-abdominal Pressure
Transdiaphragmatic Pressure
Stress Index
Flow
Stress and Strain
End-Expiratory Lung Volume
Respiratory System Compliance
Chest Wall Compliance
Lung Compliance
Airways Resistance
Work of Breathing
Pressure–Volume Curves
Flow-Volume Loops
Tension-Time Index and Pressure-Time Product
Key Points
References
Chapter 52 Control of Breathing
Introduction
Control of Breathing
Role of the Medulla Oblongata
Role of the Pons
Respiratory Reflexes
Innervation of the Lungs
Central and Peripheral Chemoreceptors
Factors That Affect Control of Breathing
Effects of Acid–Base Disorders
Respiratory Acidosis
Metabolic Acidosis
Respiratory Alkalosis
Compensated Metabolic Alkalosis
High Altitude and Control of Breathing
Acute Effects
Chronic Effects
Hypoxic Drive
Opioid Drugs and Respiratory Drive
Abnormal Breathing Patterns
Respiratory Drive and Exercise
Assessing Respiratory Drive
Key Points
References
Chapter 53 Cardiovascular, Renal, and Neural Anatomy and Physiology
Introduction
Cardiovascular Anatomy and Physiology
The Heart
Intrinsic Conduction
Extrinsic Conduction
The Circulatory System
Renal Anatomy and Physiology
External Anatomy of the Kidney
Internal Anatomy
Nephron
Blood Supply
Physiology of the Kidney
Glomerular Filtration
Tubular Reabsorption
Tubular Secretion
Urine
Neural Anatomy and Physiology
Brain
Intracranial Pressures and Cerebral Perfusion Pressure
Spinal Cord
Peripheral Nervous System
Key Points
Suggested Reading
Chapter 54 Physical Principles
Introduction
Basic Physics
Molecules and States of Matter
Units of Measurement
Mass, Force, Stress, Pressure, and Work
Wall Tension and Surface Tension
Temperature
Thermodynamics and Heat Exchange
Gas Laws
Gas Mixtures and Partial Pressures
Humidity, Water Vapor, and Evaporation
Evaporation and Condensation
Gases in Solution, Diffusion, and Osmosis
Conversion of Gas Volumes
Conservation of Energy
Fluid Flow
Principle of Continuity
Bernoulli and Venturi Principles
Viscosity
Laminar and Turbulent Flow
Hagen-Poiseuille Equation
Flow, Resistance, and Pressure
Application of Physical Principles to Measurement
Principles of Measurement
Common Methods of Measuring Flow in Respiratory Care
Key Points
Chapter 55 Chemistry for Respiratory Care
Introduction
Basic Chemistry
Matter
Chemical Bonding
Chemical Reactions
Liquid Mixtures
Inorganic Molecules
Water
Oxygen and Carbon Dioxide
Electrolytes
Acids, Bases, and Buffers
Salts
Organic Molecules
Carbohydrates
Proteins
Lipids
Nucleic Acids
Vitamins
Hormones
Cytokines
Enzymes
Fluid Balance
Metabolic Pathways
Key Points
Suggested Reading
Chapter 56 Respiratory Microbiology
Introduction
Bacteria
Bacterial Microbiology
Common Bacteria Associated with Respiratory Disease
Streptococcus pneumoniae
Staphylococcus aureus
Haemophilus influenzae
Klebsiella pneumoniae
Pseudomonas aeruginosa
Acinetobacter baumannii
Chlamydophila pneumoniae
Mycoplasma pneumoniae
Legionella pneumophila
Rickettsiae
Mycobacteria
Viruses
Fungi
Pneumocystis jirovecii
Parasites
Common Respiratory Infections
Upper Respiratory Tract Infections
Lower Respiratory Tract Infections
Sampling Methods
Sputum Induction
Bronchoscopy
Transtracheal Aspiration
Endobronchial Ultrasound Bronchoscopy
Nonbronchoscopic Bronchoalveolar Lavage
Tracheal Aspirates
Pleural Fluid Analysis
Microbiology Techniques
Sputum Culture
Respiratory Tract Culture
Virologic Studies
Antimicrobial Therapy
Antimicrobial Resistance
Targeted Antimicrobial Therapy
Key Points
References
Chapter 57 Respiratory Drugs
Introduction
Pharmacokinetics, Pharmacodynamics, and Drug Delivery
Systemic Corticosteroids
Inhaled Corticosteroids
Beta-Adrenoceptor Agonists
Short-Acting β2-Agonists
Long-Acting β2-Agonists
Epinephrine
Anticholinergic Agents
Methylxanthines
Phosphodiesterase Inhibitors
Leukotriene Modifiers
Mast Cell Stabilizers
Anti-IgE Therapy
Inhaled Antimicrobial Therapy
Secretion Modifiers
Acetylcysteine
Dornase Alfa
Hypertonic Saline
Antihistamines
Anticholinergic Agents
Medications to Treat Interstitial Pulmonary Fibrosis
Neuromuscular Blocking Agents
Sedatives
Etomidate
Benzodiazepines
Opioids
Ketamine
Propofol
Dexmedetomidine
Medications to Treat Pulmonary Arterial Hypertension
Vasopressors and Inotropes
Drug-Induced Methemoglobinemia
Drugs That Prevent Deep Vein Thrombosis, Stress Ulcers, and Delirium
Diuretics
Key Points
References
Chapter 58 History of the Respiratory Care Profession
Introduction
Historical Events and Key Advances in Medical-Related Sciences
Ancient Times
The Middle Ages
The Renaissance: The 14th to 17th Centuries
The 18th Century
The 19th Century
Evolution of Respiratory Care in the 20th and 21st Centuries
Historical Events That Signaled the Evolution of Respiratory Care
Clinical Oxygen Therapy
Medicated Aerosols
Airway Management and Resuscitation
Mechanical Ventilation
Major Recent Historical Advances in Medicine and Medical Technology
Milestones in the Organizations Within the Respiratory Care Profession: Beginning Years
History of the Professional Association
Professional Publications
History of the Credentialing Organization and State Licensure
History of Respiratory Care Education and Program Accreditation
Respiratory Care’s Continuing Evolution: Contemporary and Future Changes
Key Points
References
Chapter 59 Professional Organizations
Introduction
American Association for Respiratory Care
Specialty Sections
Governance
Board of Directors
House of Delegates
Board of Medical Advisors
President’s Council
Executive Office
Coalition for Baccalaureate and Graduate Respiratory Therapy Education and National Association of Associate Respiratory Care
AARC Horizon Goals for 2020
American Respiratory Care Foundation
National Board for Respiratory Care
Examinations
Therapist Multiple Choice Examination
Clinical Simulation Examination
Pulmonary Function Technology Examination
Neonatal/Pediatric Respiratory Care Specialty Examination
Sleep Disorders Specialty Examination
Adult Critical Care Specialty Examination
Commission on Accreditation for Respiratory Care
Accreditation Process
National Association for Medical Direction of Respiratory Care
Publications
American College of Chest Physicians
Membership
Educational Offerings
Relationship with Respiratory Care
American Thoracic Society
Research and Education
Patient Care Advocacy
Relationship with Respiratory Care
American Society of Anesthesiologists
Research and Education
Relationship with Respiratory Care
Society of Critical Care Medicine
Journals and Relationship with Respiratory Care
Interprofessional Education Collaborative
Relationship to Respiratory Care
Association of Schools of Advancing Health Professions
Publications
Relationship to Respiratory Care
The Joint Commission
Relationship to Respiratory Care
National Asthma Educator Certification Board
Certified Asthma Educator
AE-C Examination
Association of Asthma Educators
American Academy of Sleep Medicine
Publications
Membership
Board of Registered Polysomnographic Technologists
Examinations
New Directions in Respiratory Care
Key Points
References
Chapter 60 Ethics of Healthcare Delivery
Introduction
Definition of Ethics
Foundations of Ethical Thinking
Personal Belief System
Attitudinal Orientation
Personal Value System
Moral Philosophy
Ethical Versus Legal Behavior
Ethical Orientation
Legal Standards
Ethical Theories
Teleological Theory
Deontological Theory
Analysis Method
Ethical Principles
Beneficence
Capacity
Nonmaleficence
Veracity
Autonomy
Confidentiality
Justice
Fidelity to Patients
Role of Professional Organizations in Ethics
Need for Professional Ethics
AARC Code of Ethics
Ethics Committees
Case Studies
Case 1. Two Lives Inseparable
Case 2. A Fifty for Your Trouble
Case 3. A Double-Edged Sword
Case 4. To Intubate or Not to Intubate
Case 5. Nosy Therapists
Case 6. You Can Tell Mom
Case 7. Who Gets the Therapy?
Case 8. A Couple of Beers
Key Points
References
Appendix 60-1
Chapter 61 Healthcare Economics
Introduction
Basic Healthcare Functions
Stakeholders in the U.S. Healthcare System
The Respiratory Therapist’s Role in Balancing Cost and Care
Forces Influencing Healthcare Costs
Increase in Cost Without Increase in Quality
Technology
Aging Population
Fragmentation of the Industry
Excess Capacity
Unnecessary Care and Defensive Medicine
Growth of Underinsured and Uninsured
Consumerism
Summary of Forces Influencing Healthcare Costs
A Brief History and Overview of Financing Healthcare
Retrospective Payment
Prospective Payment
Capitation
The Managed Care Era
Health Maintenance Organizations
Preferred Provider Organizations
Point-of-Service Plans
Exclusive Provider Organizations
Reimbursement Methodologies
Fee for Service
Cost Plus or Charge Minus
Prospective Reimbursement
Diagnosis-Related Groups
All-Patient Refined Diagnosis-Related Groups
Resource-Based Relative Value Scale
Bundled Charges
Managed Care Approaches
Case Mix
The Future of Healthcare Funding
Hospital Readmissions
Value-Based Purchasing
Hospital-Acquired Conditions Program
Respiratory Therapists’ Documentation and Demonstration of Value
Documenting Care: Charting
The Three Rights
Demonstrating Value
Key Points
References
Chapter 62 Respiratory Care Research and Evidence-Based Practice
Introduction
Research Design
The Study Question
Controls
Matching
Randomization
Blinding or Masking
Crossover
Observational Versus Interventional
Prospective and Retrospective
Inclusion and Exclusion Criteria
Institutional Review Boards and Informed Consent
Clinical Trial Registration
Measurements
Incidence and Prevalence
Missing Values and Dropouts
Statistical Issues
Bias
Study Types
Case Reports and Case Series
Case Control Studies
Cross-Sectional Studies
Cohort Studies
Animal Studies
Equipment Evaluations
Surveys
Randomized Controlled Trials
What Is Evidence-Based Respiratory Care?
Hierarchy of Evidence
Evidence for a Diagnostic Test
Sensitivity and Specificity
Likelihood Ratio
Receiver Operating Characteristic Curve
Evidence for a Therapy
Meta-analysis
Finding the Evidence
Internet Search
Google Scholar
PubMed
Cumulative Index to Nursing and Allied Health Literature
Web of Science
Ovid
Journal Websites
Narrative Reviews and Systematic Reviews
Clinical Practice Guidelines
Key Points
References
Glossary
Index