Page 630 - Clinical Application of Mechanical Ventilation

596 Chapter 18

Allocation of Ventilators. The Centers for Disease Control and Prevention (CDC,
2011) published an article that describes the biomedical and ethical principles for
the allocation of mechanical ventilators. Topics in the article include: respect for
persons and their autonomy, beneficence, justice, maximizing net benefits, social
worth, life cycle principle, fair chances versus maximization of best outcomes, and
who should make ventilator allocation decisions. Readers should refer to this article
for a detailed discussion and additional resources.

Personnel and Planning

In addition to personnel providing direct medical care, other personnel and ser-
vices are required during mass casualty incidents. They include transportation
and evacuation, infection and vector control, security, volunteer management,
worker health and safety, pharmacy, social service, utility outage, wastewater
The Department of and solid waste disposal, nutrition, blood products and services, food safety and
Homeland Security developed
the Homeland Security Exer- security, public health and medical information, veterinary services, victim iden-
cise and Evaluation Program tification, and mortuary services. The Department of Homeland Security de-
(HSEEP) to assist state and
local governments to develop, veloped the Homeland Security Exercise and Evaluation Program (HSEEP) to
implement, and evaluate assist state and local governments to develop, implement, and evaluate training
training exercise programs to
enhance preparedness. exercise programs to enhance emergency preparedness (Macintyre, 2009; CNA
Corporation, 2004).

MECHANICAL VENTILATION IN HYPERBARIC CONDITION

hyperbaric oxygen: supple- Hyperbaric oxygen (HBO) refers to oxygen therapy administered under a hyper-
mental oxygen under hyperbaric
conditions; used in conditions such baric condition. It has been in use extensively for conditions such as severe carbon
as severe carbon monoxide poison- monoxide poisoning, decompression sickness, gas gangrene, and anaerobic infec-
ing, decompression sickness, gas
gangrene, and anaerobic infections. tions (Vazquez et al., 2003). In some patients, intensive care support and mechanical
ventilation are necessary during HBO therapy. This section reviews the common
issues when mechanical ventilation is used in a multiplace hyperbaric chamber.
hyperbaric condition: an envi-
ronment in which the atmospheric
pressure is greater than one baro-
metric pressure (e.g., diving under Rationale for Hyperbaric Oxygenation (HBO)
water, hyperbaric chamber).

Hyperbaric oxygenation increases the amount of dissolved oxygen carried by the
multiplace hyperbaric
chamber: a large hyperbaric plasma. At an F O of 21%, the normal oxygen content is 20 vol% and the plasma
2
I
chamber designed to treat more carries about 0.3 vol% of the total oxygen content.
than one patient at a time.
Tissues require a minimum of 60 mL of oxygen per liter (60/1,000 5 6/100
or 6 vol%) of blood flow to maintain normal metabolism (Leach et al., 1998).
Tissues require a At 1 atmospheric pressure (760 mm Hg at sea level) and at an F O of 100%,
minimum of 60 mL of oxygen I 2
per liter (or 6 vol%) of blood the PaO is about 673 mm Hg and the calculated dissolved oxygen is about
2
flow to maintain normal 2 vol%. At 3 atmospheres, the dissolved oxygen is 6 vol% or 6 mL per 100 mL
metabolism in cells and many
tissues. of blood. This amount of oxygen meets the minimal requirement for normal
cellular metabolism.

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