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This welcome addition to the series Update in Intensive Care and Emergency Medicine emerges from the most recent of a series of meetings organized by Alvar Net and Salvador Benito of Barcelona. This gathering provided a forum for European intensive care specialists to exchange ideas, knowledge and experience on, the measurements feasible in mechanically ventilated patients. The scope was ambitious, ranging from basics like the measurement of airway pressure and blood gases to topics such as CT, MRI and the multiple inert gas elimination technique. The success of the meeting made publication a logical consequence. The book is unique in its breadth. The contributors, from numerous centers in Europe and North America, cover all tech niques employed in intensive care units, describing indications, contraindications, procedures, biases and complications. This volume will be an invaluable source for intensive care specialists and other clinicians. Alongside practical descriptions of procedures they employ routinely (spirometry, measurement of sys temic vascular oxygen pressure, Swan-Ganz catheterization, BOPA etc.), they will find accounts of such sophisticated techniques as on line measurement offunctional residual capacity, isotope determina tion of ventilation/perfusion ratios, diaphragmatic metabolism and peripheral oxygen exchange. I am especially happy to see the book published by Springer-Verlag, which has distinguished itself in the field of intensive care medicine.
Respiration is a unique topic among various subdisciplines of physiology. Physiolo gists and clinicians are now able to communicate quantitative functional properties of lung mechanics and gas exchange in the language of the engineer, physicist and mathematician. This is largely due to intensive and stimulating work during the last decades of brilliant minds in a handful of excellent schools in the international family of physiologists. Among these founders of respiratory physiology are a number of clinicians, and they have. taken significant ,part both in shaping the theoretical knowledge to clinical applicability and developing technical devices for diagnosis and therapy in pulmonology. However, the theory behind the evaluation of measure ments, and their interpretation in terms of clinical function tests, is so confusingly complex that the ordinary physician, not specifically trained in respiratory physiol ogy, finds himself unable to critically apply these techniques. We, therefore, need descriptions of respiratory physiology and of its clinical application presented in the language of the clinician. And that is what this book is meant to be. Written by an expert in electrical and biomedical engineering, and by an expert in intensive care medicine, this text constitutes an "operational manual" of clinical respiratory physiology. It does not intend to be another textbook of basic respiratory physiology or pathophysiology. This book not only addresses practical clinicians, particularly those of intensive care medicine, by describing the essentials of clinically relevant respiratory knowledge.
This book comprehensively addresses the use of pulmonary function measurement for the evaluation, screening and timing of noninvasive mechanical ventilation (NIMV) from hospital to home care. To do so, it describes three clinical stages of NIMV support: before NIV, to detect early markers and determine whether NIV is appropriate; during NIV, to evaluate NIV response; and in long-term NIV support. Additionally, it assesses a range of complementary health care organizations (pulmonary function labs, pneumology wards, semi-intensive care units and home mechanical ventilation programs), techniques (chest physiotherapy/airway secretions, etc.) and applications. In closing, the book offers practical recommendations on how noninvasive ventilation and lung function measurement can improve outcomes and quality of life, making it a valuable resource for all specialists, e.g. intensivists and pneumologists, as well as anesthesiologists and therapists.
Although diagnosis always begins with a careful history and physical examination and a physician is obligated to consider more than the diseased organ, testing of lung function has become standard practice to confirm the diagnosis, evaluate the severity of respiratory impairment, assess the therapy response and follow-up patients with various cardio-respiratory disorders. Ventilation, diffusion, blood flow and control of breathing are the major components of respiration and one or more of these functional components can be affected by any disorder. Frequently, no single pulmonary function test.
Simplify, simplify! Henry David Thoreau For writers of technical books, there can be no better piece of advice. Around the time of writing the first edition – about a decade ago – there were very few monographs on this s- ject: today, there are possibly no less than 20. Based on critical inputs, this edition stands thoroughly revamped. New chapters on ventilator waveforms, airway humidification, and aerosol therapy in the ICU now find a place. Novel software-based modes of ventilation have been included. Ventilator-associated pneumonia has been se- rated into a new chapter. Many new diagrams and algorithms have been added. As in the previous edition, considerable energy has been spent in presenting the material in a reader-friendly, conv- sational style. And as before, the book remains firmly rooted in physiology. My thanks are due to Madhu Reddy, Director of Universities Press – formerly a professional associate and now a friend, P. Sudhir, my tireless Pulmonary Function Lab technician who found the time to type the bits and pieces of this manuscript in between patients, A. Sobha for superbly organizing my time, Grant Weston and Cate Rogers at Springer, London, Balasaraswathi Jayakumar at Spi, India for her tremendous support, and to Dr. C. Eshwar Prasad, who, for his words of advice, I should have thanked years ago. vii viii Preface to the Second Edition Above all, I thank my wife and daughters, for understanding.
This reference surveys current best practices in the prevention and management of ventilator-induced lung injury (VILI) and spans the many pathways and mechanisms of VILI including cell injury and repair, the modulation of alveolar-capillary barrier properties, and lung and systemic inflammatory consequences of injurous mechanical ventilation. Cons
This volume, the second in a series on topics in microcomputers in critical care and pulmonary physiology,' contains the proceedings of the Second International Symposium on Computers in Critical Care and Pulmonary Medicine, held at the University of Lund in 1980 under the.,chairmanship of Prof. B. Jonson, M.D., Department of Clinical Physiology, University of Lund, Sweden. Clinicians and biomedical engineers from many countries parti cipated in a three day deliberation. Of special interest was the introduction of nuclear techniques in pulmonary medicine for the first time in this symposium series. It is the intention of the steering committee that such meetings should take place on an annual basis in the rapidly changing world of the science and technology of computing in clinical care, in prac tice and in pulmonary medicine. Editorial modification of the papers in this volume has been kept to a minimum. Changes have been made to ensure some uniformity in presentation and there has been some alteration of the English to avoid ambiguity, but our intervention has gone no further than that. It is hoped that the contents of this volume will enable those who are interested in the subject matter to be more aware of research developments occurring in so many different disciplines and so many different centres in America and Europe. Finally, I would like to thank Miss Bodil Richardson for her or ganisational and secretarial help. Thanks are also due to Prof. J.P.
This book covers the up-to-date advancement of respiratory monitoring in ventilation support as well as detecting the physiological responses to therapeutic interventions to avoid complications. Mechanical ventilation nowadays remains the cornerstone in life saving in critically ill patients with and without respiratory failure. However, conclusive evidences show that mechanical ventilation can also cause lung damage, specifically, in terms of ventilator-induced lung injury. Respiratory monitoring encloses a series of physiological and pathophysiological measurements, from basic gas exchange and ventilator wave forms to more sophisticated diaphragm function and lung volume assessments. The progress of respiratory monitoring has always been accompanied by advances in technology. However, how to properly conduct the procedures and correctly interpret the data requires clear definition. The book introduces respiratory monitoring techniques and data analysis, including gas exchange, respiratory mechanics, thoracic imaging, lung volume measurement, and extra-vascular lung water measurement in the initial part. How to interpret the acquired and derived parameters and to illustrate their clinical applications is presented thoroughly. In the following part, the applications of respiratory monitoring in specific diseases and conditions is introduced, including acute respiratory distress syndrome, obstructive pulmonary diseases, patient-ventilator asynchrony, non-invasive ventilation, brain injury with increased intracranial pressure, ventilator-induced diaphragm dysfunction, and weaning from mechanical ventilation. This book is intended primarily for ICU physicians and other practitioners including respiratory therapists, ICU nurses and trainees who come into contact with patients under mechanical ventilation. This book also provides guidance for clinical researchers who take part in respiratory and mechanical ventilation researches.
Medical Ventilator System Basics: A clinical guide is a user-friendly guide to the basic principles and the technical aspects of mechanical ventilation and modern complex ventilator systems. Designed to be used at the bed side by busy clinicians, this book demystifies the internal workings of ventilators so they can be used with confidence for day-to-day needs, for advanced ventilation, as well as for patients who are difficult to wean off the ventilator. Using clear language, the author guides the reader from pneumatic principles to the anatomy and physiology of respiration. Split into 16 easy to read chapters, this guide discusses the system components such as the ventilator, breathing circuit, and humidifier, and considers the major ventilator functions, including the control parameters and alarms. Including over 200 full-colour illustrations and practical troubleshooting information you can rely on, regardless of ventilator models or brands, this guide is an invaluable quick-reference resource for both experienced and inexperienced users.
Now in paperback, the second edition of the Oxford Textbook of Critical Care is a comprehensive multi-disciplinary text covering all aspects of adult intensive care management. Uniquely this text takes a problem-orientated approach providing a key resource for daily clinical issues in the intensive care unit. The text is organized into short topics allowing readers to rapidly access authoritative information on specific clinical problems. Each topic refers to basic physiological principles and provides up-to-date treatment advice supported by references to the most vital literature. Where international differences exist in clinical practice, authors cover alternative views. Key messages summarise each topic in order to aid quick review and decision making. Edited and written by an international group of recognized experts from many disciplines, the second edition of the Oxford Textbook of Critical Careprovides an up-to-date reference that is relevant for intensive care units and emergency departments globally. This volume is the definitive text for all health care providers, including physicians, nurses, respiratory therapists, and other allied health professionals who take care of critically ill patients.