Mechanical Ventilation 1st ed 2015
126 pág.

Mechanical Ventilation 1st ed 2015


DisciplinaVentilaçao Mecanica171 materiais1.136 seguidores
Pré-visualização30 páginas
Mechanical Ventilation
Prelimes.indd 1 6/16/2015 4:20:52 PM
Prelimes.indd 2 6/16/2015 4:20:52 PM
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
Prelimes.indd 3 6/16/2015 4:20:53 PM
 Jaypee Brothers Medical Publishers (P) Ltd
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Overseas O\ufffd ces
J.P. Medical Ltd Jaypee-Highlights Medical Publishers Inc
83 Victoria Street, London City of Knowledge, Bld. 237, Clayton
SW1H 0HW (UK) Panama City, Panama
Phone: +44 20 3170 8910 Phone: +1 507-301-0496
Fax: +44 (0)20 3008 6180 Fax: +1 507-301-0499
Email: info@jpmedpub.com Email: cservice@jphmedical.com
Jaypee Medical Inc Jaypee Brothers Medical Publishers (P) Ltd
The Bourse 17/1-B Babar Road, Block-B, Shaymali
111 South Independence Mall East Mohammadpur, Dhaka-1207
Suite 835, Philadelphia, PA 19106, USA Bangladesh
Phone: +1 267-519-9789 Mobile: +08801912003485
Email: jpmed.us@gmail.com Email: jaypeedhaka@gmail.com
Jaypee Brothers Medical Publishers (P) Ltd
Bhotahity, Kathmandu, Nepal
Phone: +977-9741283608
Email: kathmandu@jaypeebrothers.com
Website: www.j1aypeebrothers.com
Website: www.jaypeedigital.com
© 2015, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/
author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any 
form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the 
prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks 
or registered trademarks of their respective owners. The publisher is not associated with any 
product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, 
authoritative information about the subject matter in question. However, readers are advised 
to check the most current information available on procedures included and check information 
from the manufacturer of each product to be administered, to verify the recommended dose, 
formula, method and duration of administration, adverse e\ufffd ects and contraindications. It is the 
responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher 
nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property 
arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional 
medical services. If such advice or services are required, the services of a competent medical 
professional should be sought.
Every e\ufffd ort has been made where necessary to contact holders of copyright to obtain permission 
to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be 
pleased to make the necessary arrangements at the \ufffd rst opportunity.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Mechanical Ventilation
First Edition: 2015
ISBN: 978-93-5152-771-8
Printed at
Prelimes.indd 4 6/16/2015 4:20:53 PM
Contributors
Amit Vij
Sanjeev Kumar
Vikas Taneja
Manish Kori
Prelimes.indd 5 6/16/2015 4:20:53 PM
Prelimes.indd 6 6/16/2015 4:20:53 PM
Preface
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 
lung.
\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.
Prelimes.indd 7 6/16/2015 4:20:53 PM
Prelimes.indd 8 6/16/2015 4:20:53 PM
Contents
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
Prelimes.indd 9 6/16/2015 4:20:53 PM
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.