Page 54 - Clinical Application of Mechanical Ventilation

20 Chapter 1

TABLE 1-10 Causes of Excessive Ventilatory Workload

Type Clinical Conditions

Acute airflow obstruction Status asthmaticus
Epiglotittis
COPD

Deadspace ventilation Pulmonary embolism
Decrease in cardiac output
Emphysema

Congenital heart disease Hypoplastic left heart syndrome
Tetralogy of Fallot
Persistent pulmonary hypertension
Cardiovascular Decreased cardiac output
decompensation V/Q mismatch
Deadspace ventilation
Shock Blood loss
Peripheral vasodilation
Congestive heart failure
Increased metabolic rate Fever
Increased work of breathing
Drugs Acute pulmonary edema
(narcotics, salicylates, nonsteroidal anti-inflammatory agents,
naloxone, thiazide diuretics, contrast media, insulin)
Bronchospasm
(salicylates, nonsteroidal anti-inflammatory agents,
hydrocortisone, beta-blockers, neuromuscular blocking
agents, contrast media)

Decreased compliance Acute lung injury, ARDS, IRDS
Atelectasis
Tension pneumothorax
Postthoracic surgery
Obesity
Diaphragmatic hernia
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structures. If uncorrected, this condition may lead to increased work of breathing
and eventual ventilatory and oxygenation failure.
Table 1-11 lists some clinical examples of conditions that may lead to ventila-
tory pump failure. They include chest trauma, prematurity (Watchko et al., 1994),
electrolyte imbalance (Freeman et al., 1993), and problems in geriatric patients
(Krieger, 1994).

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