Page 23 - Clinical Application of Mechanical Ventilation

Contents XXI

Definitions of ALI and ARDS 491
Pathophysiology 492
Clinical Presentations 493
Lung Protection Using Airway Pressure Thresholds 494
Low Tidal Volume and Permissive Hypercapnia 494
Decremental Recruitment Maneuver to Determine Optimal PEEP 495
Prone Positioning 496
Ventilator-Associated Pneumonia (VAP) 497
Incidence of VAP 497
Clinical Presentations 498
Prevention of VAP 499
Treatment of VAP 501
Hypoxic-Ischemic Encephalopathy (HIE) 501
General Principles of HIE 502
Cerebral Perfusion Pressure 503
Decrease in CPP Due to Cardiac Arrest 503
Decrease in CPP Due to Shock 504
Decrease in CPP Due to Brain Injury 504
Evaluation and Treatment of HIE 504
Trauma Brain Injury 505
Delayed Brain Injury 505
Acceleration and Deceleration Brain Injuries 506
Clinical Evaluation and Assessment 506
Management Strategies 507
Respiratory Management 508
Summary 509
Self-Assessment Questions 509
Answers to Self-Assessment Questions 511
References 511

Chapter 16: weaning froM MeChaniCal Ventilation

Introduction 517
Definition of Weaning Success and Failure 517
Weaning Success 518
Weaning in Progress 518
Weaning Failure 518
Patient Condition Prior to Weaning 519
Weaning Criteria 520
Ventilatory Criteria 520
Oxygenation Criteria 522
Pulmonary Reserve 524
Pulmonary Measurements 524
Rapid Shallow Breathing Index (RSBI) 526
Weaning Procedure 527
Spontaneous Breathing Trial 527

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