Mechanical Ventilation 1st ed 2015
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Mechanical Ventilation 1st ed 2015

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Mechanical Ventilation
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Series Editors
Anupam Sachdeva
Krishan Chugh
Ajay Gambhir
Satinder Aneja
AP Dubey
Shyam Kukreja
Guest Editors
Sanjeev Kumar 
Krishan Chugh
Soonu Udani
New Delhi | London | Philadelphia | Panama
The Health Sciences Publisher
Mechanical Ventilation
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 Jaypee Brothers Medical Publishers (P) Ltd
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New Delhi 110 002, India
Phone: +91-11-43574357
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Phone: +977-9741283608
© 2015, Jaypee Brothers Medical Publishers
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Mechanical Ventilation
First Edition: 2015
ISBN: 978-93-5152-771-8
Printed at
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Amit Vij
Sanjeev Kumar
Vikas Taneja
Manish Kori
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Mechanical Ventilation, while not a primary treatment application for disease 
states, is an extremely valuable respiratory support system. Every Pediatrician, 
who is confronted with critically ill children, needs to be familiar with the 
basics of intubation, bag mask ventilation, and the principles of stabilisation 
and transfer of a child. 
With a growing number of independent Intensive Care Units in the country, 
the basic tools, language and culture of \u201cventilation\u201d has become rather 
widespread. Now there is a keen desire to move forward and \ufffd ne-tune old 
skills and learn new ones. 
\ufffd is workshop is designed with just that in mind. 
\ufffd e importance of using noninvasive ventilation, wherever feasible, will 
be emphasised. \ufffd is is actually seen as a step up rather than a step down in 
the intensivists\u2019 skill in ventilation technique. High frequency still exists in 
the armamentarium of the intensivist as a rescue measure, where advanced 
ventilation techniques are considered and shall be covered. 
Besides this, a number of advanced modes of ventilation have also come in 
with the sole purpose of making the ventilation gentle and avoid asynchrony. 
\ufffd e use of ventilatory graphics has also put us in a better position to understand 
the physiology and mechanics of patient ventilator interactions in the diseased 
\ufffd is manual is intended for intensivists and pediatricians, who wish to 
delve into details. Special focus has been kept on ventilatory graphics, high 
frequency ventilation as well as noninvasive ventilation. 
We hope it meets with your expectations.
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1. Basics of Mechanical Ventilation 1
 2. Pediatric Airways and Oxygen Delivery Devices 14
 3. Disease Speci\ufffd c Ventilation 29
 4. Interpretation of Graphic Displays on Ventilators 37
Amit Vij
 5. High Frequency Ventilation 50
Sanjeev Kumar
 6. Non-invasive Ventilation in Children 59
 7. \u201cBubble CPAP\u201d for Neonates 64
 8. Newer Modes of Ventilation 71
 9. Humidi\ufffd cation and Mechanical Ventilation 86
 10. Complications of Mechanical Ventilation 93
Vikas Taneja
 11. Troubleshooting and Monitoring During
Mechanical Ventilation 104
 12. Extracorporeal Membrane Oxygenation 109
Manish Kori
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Applied Physiology of Ventilation
Mechanical ventilation in children and neonates is different from adults. While 
basic principles of physics and gas flow apply to all age groups, anatomical 
and physiological differences play a significant role in selecting the type of 
ventilator as well as ventilatory modes and settings.
The upper airway in infants is cephalad, funnel shaped with its narrowest 
area being at the subglottic region (at the level of cricoid ring as compared to 
the relatively tubular adult airway. Airway resistance increases inversely by 
4th power of the radius; i.e. in an already small airway even 1 mm of edema 
or secretions will increase the airway resistance and turbulent flow markedly 
necessitating treatment of airway edema, suctioning of secretion, measures 
to control secretions. Low functional residual capacity (FRC: Volume of air in 
the lungs at end of expiration) reduces the oxygen reserve and hence the time 
that apnea can be tolerated by a child.
Respirations are shallow and rapid due to predominant diaphragmatic 
breathing, and inadequate chest expansion due to the more horizontal alignment 
of the ribs in infancy giving less play in the bucket handle movement of the ribs 
during inspiration. Therefore, a child tends to get tachypneic rather than increasing 
the depth of respiration in response to hypoxemia. Oxygen consumption per kg 
body weight is higher therefore tolerance to hypoxemia is lower.
Susceptibility to bradycardia in response to hypoxemia is also higher due 
to high vagal tone. Pores of Kohn and channels of Lambert (bronchoalveolar 
and interalveolar collaterals) are inadequately developed making regional 
atelectasis more frequent. Closing volumes are lower and airway collapse due 
to inadequate strength of the cartilage in the airways is common making a 
child particularly susceptible to laryngomalacia, and tracheobronchomalacia 
as well as lower airways closure.