Page 465 - Clinical Application of Mechanical Ventilation

Pharmacotherapy for Mechanical Ventilation 431

MDI

Ventilator
Inspiratory
Tubing

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Spacer

Figure 13-2 An MDI with spacer on a ventilator circuit.

pressure-controlled or volume-controlled ventilation (Dhand, 2005). Figure 13-2
shows a typical setup of an MDI on the ventilator circuit.

NEUROMUSCULAR BLOCKING AGENTS

Neuromuscular blocking agents are administered when temporary paralysis of skel-
etal muscles is desired. Pharmacological paralysis is most commonly induced to
(1) ease endotracheal intubation, (2) relieve laryngeal spasm, (3) provide muscle
relaxation during surgery, or (4) maintain mechanical ventilation.
Paralyzing agents are used on ventilator patients in difficult situations due to un-
derlying pathology, unnatural modes of ventilation, or psychologic unacceptance.
If any of these conditions prevent adequate ventilation, oxygenation, or patient
comfort, a paralyzing agent should be considered. The benefits of paralysis during
controlled ventilation are given in Table 13-8.

TABLE 13-8 Benefits of Paralysis during Controlled Ventilation

1. Reduced combativeness and agitation

2. Relaxation of respiratory muscles
3. Increased chest wall compliance

4. Synchronization during unnatural modes of ventilation (e.g., inverse I:E)

5. Prevention of hypoxemia associated with increased work of breathing
6. Decreased intracranial pressures caused by excessive movement
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