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Reorganized to better reflect the order in which mechanical ventilation is typically taught, this text focuses on the management of patients who are receiving mechanical ventilatory support and provides clear discussion of mechanical ventilation and its application. The 4th edition features two-color illustrations, an increased focus on critical thinking, a continued emphasis on ventilator graphics, and several new chapters including non-invasive positive pressure ventilation and long-term ventilation.

Excerpts of the most recent CPGs are included to give students important information regarding indications/contraindications, hazards and complications, assessment of need, assessment of outcome, and monitoring.

Clinical Rounds boxes contain problems that may be encountered during actual use of equipment and raise questions for the student to answer.

Case studies are included as boxes throughout the chapters within boxes and Clinical Rounds.

Historical Notes provide educationally or clinically relevant information.

Chapters featuring topics such as methods to improve ventilation, frequently used pharmacologic agents in ventilated patients, cardiovascular complications, pulmonary complications, noninvasive positive pressure ventilation, and long-term ventilation have been added.

Key Point boxes have been placed sporadically throughout the chapters and highlight key information for the reader.

Increased number of NBRC-type questions reflecting the types of questions and amount of coverage on the board exams.

Respected educator J.M. Cairo has been added as co-author, bringing in a fresh voice and a wide breadth of experience.

A reorganization of chapters creates a text that is more in line with the way the course is typically taught.

lAll chapters have been heavily revised and updated, particularly the chapters on ventilator graphics, methods to improve oxygenation, and neonatal and pediatric ventilation.

A second color has been added to enhance the overall design and line drawings.

Key terms are listed at the beginning of each chapter and highlighted at first mention.

Abbreviations (inside front cover and back cover)

PART 1 Basic Concepts and Core Knowledge in Mechanical Ventilation

1 Oxygenation and Acid-Base Evaluation, 1

　　Review of Arterial Blood Gases, 2

　　Evaluating Oxygenation, 2

　　Evaluating the Transfer and Uptake of Oxygen from the Alveoli--P(A-a)O2, PaO2/PAO2, and PaCO2/F1O2, 4

　　Changes in Alveolar Ventilation Associated with Changes in PAO2 and PACO2, 6

　　Alveolar Ventilation, PaCO2, and VCO2, 7

　　Changes in pH, PaCO2, and Sodium Bicarbonate, 7

　　Changes in pH caused by Changes in PaCO2, 8

　　Changes in Plasma Bicarbonate Caused by Changes in PaCO2, 8

　　Metabolic Changes in Bicarbonate and pH, 11

2 Basic Terms and Concepts of Mechanical

　　Ventilation, 15

　　SECTION 1:Physiological Terms and Concepts

　　Related to Mechanical Ventilation, 16

　　Normal Mechanics of Spontaneous Ventilation, 16

　　Lung Characteristics, 18

　　Time Constants, 21

　　SECTION 2: Types of Ventilators and Terms

　　Applied to Mechanical Ventilation, 23

　　Types of Mechanical Ventilation, 23

　　Definition of Pressures in Positive Pressure Ventilation, 26

3 How Ventilators Work, 31

　　Historical Perspective on Ventilator Classification, 32

　　Internal Function, 32

　　Power Source or Input Power, 32

　　Control Systems and Circuits, 35

　　Power Transmission and Conversion System, 39

4 How a Breath Is Delivered, 45

　　Basic Model of Ventilation in the Lung during Inspiration, 46

　　Factors Controlled and Measured by the Ventilator during Inspiration, 47

Overview of Inspiratory Waveform Control, 48

　　Four Phases of a Breath and Phase Variables, 49

　　Beginning of Inspiration: The Trigger Variable, 50

　　Inspiratory Factors: The Limit Variable, 51

　　Termination of the Inspiratory Phase: The Cycling Mechanism(Cycle Variable), 54

　　Types of Breaths, 56

　　Expiratory Phase: The Baseline Variable, 57

PART 2 Initiating Ventilation

　5 Establishing the Need for Mechanical

　　Ventilation, 63

　　Acute Respiratory Failure, 64

　　Patient History and Diagnosis, 65

　　Physiological Measurements in Acute Respiratory Failure, 69

　　Overview of Criteria for Mechanical Ventilation, 72

　　Possible Alternatives to Invasive Ventilation, 72

　　Patient Cases, 75

　6 Selecting the Ventilator and the Mode, 81

　　invasive or Noninvasive Ventilation: Selecting the Patient Interface, 82

　　Methods of Noninvasive Support and Appropriate Patient Interfaces, 82

　　Full and Partial Ventilatory Support, 84

　　Mode of Ventilation and Breath Delivery, 84

　　Type of Breath Delivery, 84

　　Targeting Volume as the Control Variable, 84

　　Targeting Pressure as the Control Variable, 85

　　Breath Delivery and Modes of Ventilation, 87

　　Bilevel Positive Airway Pressure, 96

　　Closed Loop Ventilation, 96

　　Less Frequently Used Closed Loop Modes of Ventilation, 97

　7 Initial Ventilator Settings, 105

　　Determining Initial Ventilator Setting during Volume Ventilation, 106

　　SECTION I: Initial Settings during Volume

　　Ventilation, 106

　　Setting Minute Ventilation, 106

　　Tidal Volume and Rate, 108

　　Relationship of Tidal Volume, Flow, Total Cycle Time, and

　　 Inspiratory to Expiratory Ratio, 111

　　Inspiratory Flow and Flow Patterns, 113

　　Setting the Minute Ventilation: Special Considerations, 116

　　inspiratory Pause during Volume Ventilation, 116

　　Actual Clinical Examples of Ventilator Adjustment, 117

　　……

PART 3　Monitoring in Mechanical Ventilation

PART 4 Therapeutic Interventions-Making Appropriate Changes

PART 5 Effects and Complications Mechanical Vintilation

PART 6 Noninvasive Positive Pressure Ventilation

PART 7 Discontinuation from Ventilation and Long-Term Ventilation

PART 8 Special Applications of Mechanical Vietialtion

Appendix A

Appendix B

Appendix C

Glossary

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