Page 524 - Clinical Application of Mechanical Ventilation

490 Chapter 15

Key Terms

acute lung injury (ALI) hypoxic-ischemic encephalopathy
acute respiratory distress syndrome (HIE)
(ARDS) lung protection strategy
cerebral perfusion pressure (CPP) permissive hypercapnia

clinical pulmonary infection score prone positioning
(CPIS) subglottic secretion drainage
decremental recruitment maneuver transtentorial herniation
Glasgow coma scale (GCS) ventilator-associated pneumonia (VAP)

Learning Objectives

After studying this chapter and completing the review questions, the learner
should be able to:

Use the clinical criteria to differentiate between ALI and ARDS.
Describe the management of ALI and ARDS using airway pressure thresh-
olds, low tidal volume, permissive hypercapnia, recruitment maneuver, and
prone positioning.
Outline the clinical signs, prevention, and treatment of ventilator-associated
pneumonia.
List the factors that lead to hypoxic-ischemic encephalopathy.
Describe the management of hypoxic-ischemic encephalopathy.
Outline the clinical signs and respiratory management of traumatic brain injury.

INTRODUCTION

Mechanical ventilation is frequently used to correct and support hypoventilation and
hypoxemia in a variety of clinical conditions. While a mechanical ventilator is a
frequently used device, its application is highly dependent on the patient’s clinical
and physiologic conditions. This chapter provides an overview of some critical care
issues that are closely related to mechanical ventilation.

ACuTE LunG InjuRy AnD ACuTE RESPIRAToRy
DISTRESS SynDRomE

acute lung injury (ALI): A condi- One complication of prolonged mechanical ventilation is induced lung injury due to
tion of sudden onset, characterized
by non-cardiogenic pulmonary overdistention and repetitive recruitment and derecruitment (opening and closing)
edema on chest radiograph and a of noncompliant lung units (Dreyfuss et al., 1998). In nonhomogenous lung diseases
PaO 2 /F I O 2 of # 300 mm Hg.
such as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS),

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