Mechanical Ventilation in Neonates and Children: A Pathophysiology-Based Management Approach

Preface
Contents
1 Mechanical Characteristics of the Lung and the Chest Wall
1.1 Lung Volumes and Capacities
1.2 Pressure
1.3 Pressure Gradients
1.4 Surface Tension
1.5 Elastance and Compliance
1.5.1 Static and Dynamic Compliance
1.5.2 Frequency Dependence of Compliance
1.6 Resistance
1.7 Flow/Volume Relationships
1.8 Equal Pressure Point (EPP)
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2 Physiology of Inflation and Deflation
2.1 Equation of Motion
2.2 Time Constant
2.2.1 Auto-PEEP and Dynamic Hyperinflation
2.3 Work of Breathing
2.3.1 Pressure–Volume Work
2.4 Airway Dynamics in Health and Disease
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3 Gas Exchange
3.1 Alveolar Gas Equation
3.2 Oxygenation and Ventilation
3.3 Distribution of Ventilation
3.4 Distribution of Perfusion
3.5 Distribution of Ventilation and Perfusion
3.6 Regional V:Q Relationships (West Zones)
3.7 Ventilation (V) and Perfusion (Q) Mismatch
3.8 O2 Transport and Utilization
3.9 Abnormalities of Gas Exchange
3.10 Regulation of Respiration
3.10.1 Central Respiratory Controller
3.10.2 Sensors
3.10.3 Effectors
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4 Clinical Examination and Assessment
4.1 Importance of Clinical Examination
4.2 Respiratory Distress and Respiratory Failure
4.3 Characterizing Severity of Disease with Clinical Examination
4.4 Using Clinical Signs to Locate Site of Pathophysiology
4.5 Presentation Profiles of Respiratory Failure in Childhood
4.6 Respiratory Distress Without Respiratory Disease
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5 Monitoring
5.1 Gas Exchange
5.1.1 Assessment of Arterial Oxygenation
5.1.2 Assessment of Oxygen Transport
5.1.3 Assessment of Ventilation
5.1.4 Blood Gases
5.2 Respiratory Mechanics in Ventilated Patients
5.3 Respiratory Neuromuscular Function
5.3.1 Breathing Pattern
5.3.2 Maximum Inspiratory Airway Pressure
5.3.3 Assessment of Patient Effort
5.3.4 Esophageal and Gastric Manometry
5.3.5 Diaphragmatic Ultrasonography
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6 Ventilators and Modes
6.1 Basic Concepts and Design
6.1.1 Spontaneous Breathing
6.1.2 Equation of Motion
6.2 Basic Design of a Ventilator
6.3 Modes of Ventilation
6.3.1 Ventilator Breath
6.3.2 Control Variables
6.3.3 Phases of a Breath
6.3.4 Classification of Breaths
6.3.5 Breath Sequences
6.3.6 Ventilatory Pattern
6.3.7 Targeting Schemes
6.4 Commonly Used Modes
6.4.1 Volume-Controlled Mandatory Breaths
6.4.2 Pressure-Controlled Mandatory Breaths
6.4.3 Pressure-Regulated Volume Control
6.4.4 Selection of Parameters for Mandatory Breaths
6.4.5 Pressure-Support Ventilation
6.4.6 Volume Support Ventilation
6.5 Other Modes
6.5.1 Neurally Adjusted Ventilatory Assist (NAVA)
6.5.2 Airway Pressure Release Ventilation
6.6 High Frequency Ventilation
6.6.1 Definitions and Description
6.6.2 High Frequency Oscillatory Ventilation
6.6.3 High Frequency Jet Ventilation
6.6.4 Clinical Applications
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7 Mechanical Ventilation Strategies
7.1 Pathophysiologic Considerations
7.1.1 Alveolar Ventilation (VA)
7.1.2 Time Constant
7.1.3 Functional Residual Capacity
7.1.4 Pressure–Volume (P–V) Relationship
7.2 Planning of Mechanical Ventilation in Individual Situations
7.2.1 Phases of Respiratory Cycle
7.2.2 Initiation of Inspiration and the Control Variable (Mode)
7.3 Weaning and Extubation
7.3.1 The Weaning Process
7.3.2 Initiation of Weaning
7.3.3 Weaning Techniques
7.3.4 ERT Trials
7.3.5 Extubation
7.4 Ventilator Induced Lung Injury
7.4.1 Airway Injury
7.4.2 Biotrauma, Atelectrauma, Oxytrauma
7.4.3 Ventilator-Associated Pneumonia
7.5 Heart–Lung Interactions
7.5.1 Mechanical Heart–Lung Interactions
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8 Mechanical Ventilation for Neonates
8.1 Respiratory Distress Syndrome (RDS)
8.1.1 Pathophysiologic Considerations
8.1.2 Prevention of RDS
8.1.3 Delivery Room Stabilization
8.1.4 Respiratory Support in the Delivery Room
8.1.5 Respiratory Support During Hospital Stay
8.1.6 Role of Surfactant in Patients with RDS
8.2 Bronchopulmonary Dysplasia
8.2.1 Pathophysiology of BPD and Approach to Respiratory Support
8.2.2 Respiratory Support for Patients with BPD
8.2.3 Respiratory Support at Home
8.3 Meconium Aspiration Syndrome (MAS)
8.3.1 Pathophysiology
8.3.2 Management at Delivery
8.3.3 Approach to Ventilation
8.3.4 Ventilator Weaning Strategies in MAS
8.4 Congenital Diaphragmatic Hernia
8.4.1 Prenatal Diagnosis and Fetal Surgery
8.4.2 Pathophysiology
8.4.3 Management at Delivery
8.4.4 Approach to Ventilation
8.4.5 Pulmonary Hypertension in MAS and CDH
8.5 Consideration of Extracorporeal Membrane Oxygenation (ECMO)
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9 Ventilator Graphics
9.1 Identifying the Phases of a Mechanical Breath
9.2 Identifying the Mode of Ventilation
9.3 Recognizing and Measuring Respiratory System Mechanics
9.3.1 Increased Lower Airway resistance
9.3.2 Decreased Respiratory System Compliance
9.4 Patient-Ventilator Interactions
9.5 Trouble-Shooting Suboptimal Ventilator Performance
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10 Noninvasive Mechanical Ventilation
10.1 Non-Invasive Positive Pressure Ventilation (NIPPV)
10.1.1 Indications and Contraindications
10.1.2 Clinical Application
10.1.3 Ventilator Settings
10.1.4 Optimizing Patient-Ventilator Interaction
10.1.5 Mechanisms of Improvement
10.1.6 Equipment
10.1.7 Complications and Concerns During Short-Term NIPPV
10.2 Negative-Pressure Ventilation
10.2.1 Indications
10.2.2 Contraindications and Side-Effects
10.2.3 Equipment for NPV
10.2.4 Available Controls
10.2.5 Available Modes
10.2.6 Secretion Clearance and Cough Assist
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11 Respiratory Care Equipment
11.1 Oxygen Delivery Devices
11.2 Humidification Systems
11.3 Respiratory Care Therapeutics
11.4 Specialty Gases
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12 Long-Term Ventilation and Home Care
12.1 Definitions and Causes
12.2 Pathophysiological Considerations of Chronic Respiratory Failure
12.3 Approach to Long-Term/Home Care Ventilation
12.4 Logistics of Home Care
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13 Case-Based Analysis of Respiratory Failure
13.1 Breathing Control Disorders
13.2 Heart Failure
13.3 Lower Airway Obstruction
13.4 Parenchymal Lung Disease
13.5 Restrictive Chest Disease
13.6 Respiratory Pump Disorder
13.7 Abdominal Distension
Index