Page 488 - Clinical Application of Mechanical Ventilation

454 Chapter 13

TABLE 13-22 Signs and Symptoms of Methemoglobinemia

Methemoglobin
Concentration Clinical Signs and Symptoms

10% to 20% Central cyanosis of trunk and limbs, usually
asymptomatic

20% to 45% CNS depression (headache, dizziness, fatigue,
lethargy, syncope)

45% to 55% Coma, arrhythmia, shock, convulsion

.70% High risk of death
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inhaled nitric oxide therapy. It works with a ventilator or anesthesia machine to deliver
a precise and stable concentration of nitric oxide, regardless of the ventilator setting or
mode. Alarms are built-in to ensure safe and reliable therapy with continuous monitor-
ing of NO, NO , and O . The INOvent design also integrates with a system for de-
2
2
livering nitric oxide via a manual resuscitator. For NO therapy guidelines, refer to the
document by Klein (2012) in the Additional Resources section at the end of the chapter.
SUMMARY

In mechanical ventilation, different drugs are used to (1) provide bronchodilation, (2) fa-
cilitate intubation, (3) relieve pain and anxiety, (4) treat seizures or elevated intracranial
pressure, and (5) maintain patient-ventilator synchrony. These drugs can be very useful
when they are used as directed. At the same time, they must be used with care, since
adverse effects can be dangerous or even life-threathening. Practitioners are expected to
have a thorough knowledge of the indications, contraindications, and adverse effects of
the drugs that are administered to patients on mechanical ventilation.

Self-Assessment Questions

1. Bronchodilation may be induced by all of the following mechanisms except:
A. stimulating the sympathetic branch of the autonomic nervous system.
B. stimulating the parasympathetic branch of the autonomic nervous system.
C. inhibiting the enzyme phosphodiesterase.
D. inhibiting the parasympathetic branch of the autonomic nervous system.

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