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Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. David W. Chang Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. This is an electronic version of the print textbook. Due to electronic rights restrictions, some third party content may be suppressed. Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. The publisher reserves the right to remove content from this title at any time if subsequent rights restrictions require it. For valuable information on pricing, previous editions, changes to current editions, and alternate formats, please visit www.cengage.com/highered to search by ISBN#, author, title, or keyword for materials in your areas of interest. Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. David W. Chang, Ed.D., RRT–NPS Professor Department of Cardiorespiratory Care University of South Alabama Mobile, Alabama Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Clinical Application of Mechanical Ventilation, Fourth Edition David W. 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Printed in the United States of America 1 2 3 4 5 6 7 17 16 15 14 13 Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Dedicated with love to my wife, Bonnie and our children, Michelle, Jennifer, and Michael for their support in my professional endeavors and personal leisure activities Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. Contents Preface Acknowledgments Chapter 1: xxvi xxx Principles of Mechanical Ventilation Introduction Airway Resistance Factors Affecting Airway Resistance Airway Resistance and the Work of Breathing (∆P) Effects on Ventilation and Oxygenation Airflow Resistance Lung Compliance Compliance Measurement Static and Dynamic Compliance Compliance and the Work of Breathing Effects on Ventilation and Oxygenation Deadspace Ventilation Anatomic Deadspace Alveolar Deadspace Physiologic Deadspace Ventilatory Failure Hypoventilation Ventilation/Perfusion (V/Q) Mismatch Intrapulmonary Shunting Diffusion Defect Oxygenation Failure Hypoxemia and Hypoxia Clinical Conditions Leading to Mechancial Ventilation Depressed Respiratory Drive Excessive Ventilatory Workload Failure of Ventilatory Pump 2 3 3 4 5 5 6 6 7 10 10 10 11 11 11 12 12 13 14 15 16 17 18 18 18 19 VII­ Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. VIII Contents Summary Self-Assessment Questions Answers to Self-Assessment Questions References Additional Resources Chapter 2: 21 21 24 24 25 Effects of Positive Pressure Ventilation Introduction Pulmonary Considerations Spontaneous Breathing Positive Pressure Ventilation Airway Pressures Compliance Cardiovascular Considerations Mean Airway Pressure and Cardiac Output Decrease in Cardiac Output and O2 Delivery Blood Pressure Changes Pulmonary Blood Flow and Thoracic Pump Mechanism Hemodynamic Considerations Positive Pressure Ventilation Positive End-Expiratory Pressure Renal Considerations Renal Perfusion Indicators of Renal Failure Effects of Renal Failure on Drug Clearance Hepatic Considerations PEEP and Hepatic Perfusion Indicators of Liver Dysfunction Effects of Decreased Hepatic Perfusion on Drug Clearance Abdominal Considerations Effects of PEEP and Increased Intra-Abdominal Pressure Gastrointestinal Considerations Nutritional Considerations Muscle Fatigue Diaphragmatic Dysfunction Nutritional Support Nutrition and the Work of Breathing Neurologic Considerations Hyperventilation Ventilatory and Oxygenation Failure Indicators of Neurologic Impairment Summary Self-Assessment Questions Answers to Self-Assessment Questions References 27 28 28 28 29 30 30 30 31 31 32 34 34 34 35 35 36 36 38 38 38 38 39 39 40 40 41 41 41 42 43 43 44 44 45 45 48 48 Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.