Page 10 - Clinical Application of Mechanical Ventilation

VIII Contents

Summary 21
Self-Assessment Questions 21
Answers to Self-Assessment Questions 24
References 24
Additional Resources 25

Chapter 2: effeCts of positiVe pressure Ventilation

Introduction 27
Pulmonary Considerations 28
Spontaneous Breathing 28
Positive Pressure Ventilation 28
Airway Pressures 29
Compliance 30
Cardiovascular Considerations 30
Mean Airway Pressure and Cardiac Output 30
Decrease in Cardiac Output and O Delivery 31
2
Blood Pressure Changes 31
Pulmonary Blood Flow and Thoracic Pump Mechanism 32
Hemodynamic Considerations 34
Positive Pressure Ventilation 34
Positive End-Expiratory Pressure 34
Renal Considerations 35
Renal Perfusion 35
Indicators of Renal Failure 36
Effects of Renal Failure on Drug Clearance 36
Hepatic Considerations 38
PEEP and Hepatic Perfusion 38
Indicators of Liver Dysfunction 38
Effects of Decreased Hepatic Perfusion on Drug Clearance 38
Abdominal Considerations 39
Effects of PEEP and Increased Intra-Abdominal Pressure 39
Gastrointestinal Considerations 40
Nutritional Considerations 40
Muscle Fatigue 41
Diaphragmatic Dysfunction 41
Nutritional Support 41
Nutrition and the Work of Breathing 42
Neurologic Considerations 43
Hyperventilation 43
Ventilatory and Oxygenation Failure 44
Indicators of Neurologic Impairment 44
Summary 45
Self-Assessment Questions 45
Answers to Self-Assessment Questions 48
References 48

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