TY  - CHAP
M1  - Book, Section
TI  - Mechanical Ventilation for the Surgical Patient
A1  - Kacmarek, Robert M.
A1  - Hess, Dean R.
A2  - Longnecker, David E.
A2  - Mackey, Sean C.
A2  - Newman, Mark F.
A2  - Sandberg, Warren S.
A2  - Zapol, Warren M.
PY  - 2017
T2  - Anesthesiology, 3e
AB  - KEY  POINTSPatients  require  mechanical  ventilation  because  of  apnea,  acute  or  impending  acute  respiratory  failure,  or  severe  refractory  hypoxemia.The  two  basic  forms  of  mechanical  ventilation  are  pressure  ventilation  (peak  airway  pressure  constant,  tidal  volume  variable)  and  volume  ventilation  (tidal  volume  constant,  peak  airway  pressure  variable).Although  numerous  modes  of  ventilation  exist,  few  data  are  available  to  differentiate  the  benefits  of  one  mode  over  another,  and  no  mode  has  been  shown  to  improve  patient  outcome.A  major  concern  during  assisted  ventilation  is  patient-ventilator  synchrony—the  ventilator  should  be  set  to  match  the  patient’s  ventilatory  demands.  Increasing  data  indicates  asynchrony  may  have  a  negative  affect  on  patient  outcome.Automatic  positive  end-expiratory  pressure  (PEEP)  is  a  common  cause  of  patient-ventilator  dyssynchrony;  in  patients  with  obstructive  lung  disease,  properly  set  applied  PEEP  can  improve  synchrony  and  decrease  patient  efforts  to  ventilate.It  is  unnecessary  to  achieve  normal  Pao2  and  Paco2.  In  most  critically  ill  patients,  a  Pao2  of  ≥60  mmHg  is  acceptable,  and  permissive  hypercapnia  may  be  useful  in  treating  some  patients.Ventilator-induced  lung  injury  is  primarily  caused  by  localized  overdistension  and  the  opening  and  closing  of  unstable  lung  units.In  most  patients  who  are  ventilated,  the  tidal  volume  should  be  4-8  mL/kg  predicted  body  weight  (PBW),  the  plateau  pressure  should  be  <28  cm  H2O,  driving  pressure  should  be  <15  cm  H2O,  and  PEEP  should  be  set  to  avoid  the  collapse  of  unstable  lung  units.High-frequency  ventilation  has  been  shown  to  negatively  affect  the  outcome  of  patients  with  acute  respiratory  distress  syndrome  (ARDS).Airway  pressure  release  ventilation  has  not  been  shown  to  positively  affect  outcome  in  any  population  of  patients  and  demonstrates  no  outcome  benefits  over  conventional  pressure  or  volume  ventilation.Noninvasive  positive-pressure  ventilation  is  useful  to  transition  patients  who  are  at  high  risk  of  extubation  failure  from  invasive  ventilation  to  spontaneous  breathing.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1144135631
ER  -