Rapid Interpretation of Ventilator Waveforms

Jonathan B. Waugh, Vijay M. Deshpande, Melissa K. Brown, Robert Harwood (Autoren)

Buch | Softcover

160 Seiten

2006 | 2nd edition
Pearson (Verlag)
978-0-13-174922-1 (ISBN)

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Designed for courses in Mechanical Ventilation and/or Ventilation Graphics, this text introduces ventilator waveforms. It is intended to serve as a complement to a mechanical ventilation textbook and as a reference convenient to carry in the clinical environment. The first chapter provides clean, easy-to-read conceptual illustrations to aid in comprehension. Examples of real waveforms are provided next to the conceptual renderings to allow the learner to become comfortable with viewing waveforms with normal artifact present. The following chapters utilize mostly real recordings of ventilator waveforms. The rationale behind the format of this text is to provide a simple, portable reference and workbook that can be used at the bedside as well as the classroom. Descriptions and commentary are kept to a minimum to enhance clarity and readability. Ventilator waveform topics that are experimental, in limited use, or not considered mainstream are not included in keeping with this book’s introductory theme. It would be impractical and ponderous to attempt to include all possible examples of ventilator waveforms that can be seen in the clinical setting. The goal of this book is to impart an understanding of how waveforms are generated, which will allow the practitioner to deduce the cause and implications of previously unseen as well as familiar waveforms. Understanding waveforms, instead of memorizing many patterns, aids in problem solving and correction of abnormal conditions and prepares clinicians to adapt to future yet unknown modes of ventilation.

CONTENTS

PREFACE vii

1. VENTILATOR GRAPHICS AND CLINICAL APPLICATIONS 1

I. Basic Concepts, 1

II. Effect of Setting Changes on Waveforms, 2

III. Effect of Flow Rate on Inspiratory and Expiratory Time, 4

IV. Effect of Resistance and Compliance Changes, 6

V. Scalars, 8

VI. Modes of Ventilation and Corresponding Scalars, 10

Control Mode Ventilation, 10

Assist Mode Ventilation, 13

Sychronized Intermittent Mandatory Ventilation

(SIMV), 15

SIMV with Pressure Support Ventilation (PSV), 17

SIMV with PSV and Continuous Positive Airway Pressure

(CPAP), 19

Pressure Control Ventilation (PCV), 21

2. PRESSURE-VOLUME AND FLOW-VOLUME LOOPS 23

I. Total Lung Compliance, 23

II. Pressure-Volume Loops, 27

III. Work-of-Breathing, 32

IV. Flow-Volume Loops, 34

V. Interpretation of Loops, 36

3. WAVEFORMS FOR COMMON VENTILATOR MODES 53

I. Volume-Targeted Scalars, 55

Volume-Targeted Control Ventilation, 55

Volume-Targeted Assist Control Ventilation, 55

Volume-Targeted SIMV, 55

II. Pressure-Targeted Scalars, 57

Pressure-Targeted Control Ventilation, 57

Pressure-Targeted Assist Control Ventilation, 57

Pressure-Targeted SIMV, 57

III. Spontaneous Scalars, 59

Continuous Positive Airway Pressure (CPAP), 59

Pressure Support Ventilation (PSV), 59

PSV with CPAP, 59

Setting Rise Time for PSV, 60

Bilevel and APRV, 61

iii

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IV. Combination Modes: Volume-Targeted Scalars, 63

Volume-Targeted SIMV with CPAP, 63

Volume-Targeted SIMV with PSV, 63

Volume-Targeted SIMV with PSV and CPAP, 63

V. Combination Modes: Pressure-Targeted Scalars, 65

Pressure-Targeted SIMV with CPAP, 65

Pressure-Targeted SIMV with PSV, 65

Pressure-Targeted SIMV with PSV and CPAP, 65

VI. Volume-Targeted Pressure-Volume (P-V) and

Flow-Volume (F-V) Loops, 67

Volume-Targeted Controlled Ventilation with a

Constant Flow, 67

Volume-Targeted Assisted Ventilation with a

Constant Flow, 67

Volume-Targeted SIMV, 67

VII. Pressure-Targeted P-V and F-V Loops, 69

Pressure-Targeted Controlled Ventilation, 69

Pressure-Targeted Assisted Ventilation, 69

Pressure-Targeted SIMV, 69

VIII. Spontaneous Ventilation P-V and F-V Loops, 71

CPAP, 71

PSV, 71

PSV with CPAP, 71

IX. Combination Modes: Volume-Targeted P-V and F-V Loops, 73

Volume-Targeted SIMV with CPAP, 73

Volume-Targeted SIMV with PSV, 73

Volume-Targeted SIMV with PSV and CPAP, 73

X. Combination Modes: Pressure-Targeted P-V and F-V Loops, 75

Pressure-Targeted SIMV with CPAP, 75

Pressure-Targeted SIMV with PSV, 75

Pressure-Targeted SIMV with PSV and CPAP, 75

4. MONITORING PRESSURE AND VOLUME VENTILATION 77

I. Volume vs. Pressure Ventilation Scalars, 78

II. Inspiratory Pause During Volume and Pressure Ventilation, 79

III. Effects on Increased Airways Resistance on Volume- and Pressure-

Targeted Ventilation, 81

IV. Effects of Decreased Compliance, 84

V. Three conditions for Pressure-Targeted Breaths, 85

VI. Descending Ramp Flow in Pressure Control, Pressure Supported,

and Volume-Targeted Breaths, 85

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5. COMMON CLINICAL FINDINGS 86

I. Changes in Respiratory System Compliance, 87

Decreased Compliance and Inflection Points, 87

Overdistension, 90

Active Exhalation, 91

II. Airway Obstruction, 92

Bronchospasm: Bronchodilator Benefit Assessment, 92

Air-trapping from Dynamic Hyperinflation, 94

Air-trapping from Early Small Airway Collapse, 96

Kinked Endotracheal Tube, 98

III. Patient-Ventilator Dyssynchrony, 99

Inadequate Inspiratory Flow Rate, 99

Inappropriate Trigger Sensitivity, 100

Patient and Ventilator Rates Out of Synchrony, 102

IV. Leaks, 103

6. NEONATAL APPLICATIONS 104

I. Introduction, 105

II. Normal Infant Pulmonary Functions, 106

III. Normal Scalars, Flow-Volume (F-V), and Pressure-Volume (P-V)

Loops, 107

IV. Abnormal Waveforms, 114

Improper Sensitivity Scalars, 114

Large Air Leak and Autocycling Scalars, 115

A/C Pressure Control Asychrony Scalars, 116

A/C Pressure Control F-V and P-V Loops, 117

Inadequate Flow Scalars, 118

Inadequate Rise Time or Flow, 118

Excessive Inspiratory Pressure and Flow Scalars, 119

Effect of Excessive Inspiratory Pressure on the

P-V Loop,119

Reduced Compliance F-V and P-V Loops, 120

Excessive Inspiratory Time Scalars, 121

Inspiratory Flow Termination Scalars, 122

Termination of Inspiratory Flow, 122

Breath-Stacking (Auto-PEEP) Scalars, 123

Breath-Stacking F-V and P-V Loops, 124

Obstruction to Expiratory Flow Scalars, 125

Obstruction to Expiratory F-V and P-V Loops, 126

Right Mainstem Intubation Scalars, 127

CONTENTS v

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Right Mainstem Intubation F-V and P-V Loops, 128

Progression to Extubation Scalars, 129

Turbulent Baseline Flow Rate Scalars, 130

High Frequency Ventilation, 131

Appendix A: CASE STUDIES 134

Appendix A: VENT WAVEFORMS CHECKLIST 144

BIBLIOGRAPHY 145

INDEX 147

Erscheint lt. Verlag	2.11.2006
Sprache	englisch
Maße	152 x 229 mm
Gewicht	236 g
Themenwelt	Medizin / Pharmazie ► Medizinische Fachgebiete ► Pharmakologie / Pharmakotherapie
Themenwelt	Wirtschaft
ISBN-10	0-13-174922-6 / 0131749226
ISBN-13	978-0-13-174922-1 / 9780131749221
Zustand	Neuware