Mechanical Ventilation: Applications, Technologies and Ethical Issues


Antonio M. Esquinas, MD, PhD, FCCP, FAARC – Intensive Care Unit Hospital Morales Meseguer, Murcia, Spain; Director International School of Non-Invasive Ventilation; Director International Non Invasive Ventilation Expert of College

Series: Advances in Respiratory and Critical Care Medicine
BISAC: MED079000

Currently, positive pressure mechanical ventilation has gained widespread recognition as an essential strategy in the treatment of various forms of acute and chronic respiratory failure. Its mechanism impacts directly or indirectly on respiratory physiology (gas exchange) and/or respiratory musculature in various medical/surgical pathological conditions. In addition, positive pressure mechanical ventilation has been recognized as a factor that influence both short- and long-term prognosis of critically ill patients. An example of one of the utilities of noninvasive ventilation is to assist in weaning from mechanical ventilation.

For these reasons, mechanical ventilation continues to be a matter of controversy and continuous analysis for medical community and growing field of technological advances that optimize patient-ventilator interaction and outcome. This book has made a selection of the hot topics about indications of mechanical ventilation, technological development advances, ethical and cost associated with mechanical ventilation.

Initially, the authors believe an essential approach to positive pressure ventilation is based on physiology (gas exchange, lung mechanics, work of breathing, equipment, etc.), modality of mechanical ventilators (invasive and non-invasive ventilation, nasal high flow, etc.), ventilatory modes (conventional and unconventional modes) and possible complications (ventilatory associated pneumonia, diaphragm dysfunction and ventilator-associated events). The most important mechanical ventilation topics and advances made in critically mechanical ventilated patients include obesity, severe hypoxemic respiratory failure (protective ventilation mode, prone position and extracorporeal oxygenation), cardiac surgery, lung/cardiac transplants, thoracic and brain trauma, pregnancy, and sleep breathing disorders. Patient-ventilator asynchrony, sedation and neuromuscular protocols in mechanical ventilation can be complicated by prolonged mechanical ventilation, weaning failure, sepsis and delirium. Continuous advances are being made in technologies such as diagnosis, monitoring and treatment patient-ventilator asynchrony, respiratory muscle function such as electromyography in diaphragm and lung function by ultrasound or electrical impedance.

Weaning from mechanical ventilation, hospital discharge and early mobilization are important aspects of how to identify weaning candidates-screening and planning how release from mechanical ventilation (ventilatory options, protocols), reintubation, rehabilitation and goals-directed mobilization and discharge planning from hospitals receiving long-term mechanical ventilation.

Finally, ethical and health-related cost perspectives of mechanical ventilation represent the last essential approach towards emergent issues in mechanical ventilation.
(Imprint: Nova)

Table of Contents


Chapter 1. Physiology of Mechanical Ventilation
(Saad M. AlRabeeah, PhD, Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Kingdom Saudi Arabia)

Chapter 2. Mechanical Ventilators (Invasive and Noninvasive) and Their Use
(Gerhard Laier-Groeneveld, Evangelisches Klinikum Niederrhein, Medical Clinic II, Pneumology, Ventilatory Support and Sleep, Oberhausen, Germany)

Chapter 3. Mechanical Ventilation and Ventilatory Mode Options
(Stephan Steiner, MD, and Mehti Afscharian, Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg/Lahn, Germany)

Chapter 4. Right Ventricular Dysfunction Associated with Mechanical Ventilation
(Muhammad Sajawal Ali, MD, MS, Anand Pullapilly, MD, and Rahul Nanchal, MD, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, US)

Chapter 5. Complications of Mechanical Ventilation
(Francesco Zarantonello, MD, and Tommaso Tonetti, MD, Anesthesiology and Intensive Care, University Hospital of Padova, Padova, Italy)

Chapter 6. Ventilator Associated Events
(Hala Nas, MD, and Ayman O. Soubani, MD, Department of Medicine, Wayne State University School of Medicine, Detroit, MI, US)

Chapter 7. High Flow Nasal Cannula in Adult Patients
(Stefano Bambi, PhD, and Adriano Peris, MD, MD, Trauma and ECMO Intensive Care Unit, Careggi Teaching Hospital, Florence, Italy)

Chapter 8. Non-Invasive Ventilation – Pathophysiology Perspective
(Erica Altschul, DO, Oki Iashikawa, DO, and Bushra Mina, MD, Division, Pulmonary Critical Care Medicine, Lenox Hill Hospital, Zucker School of Medicine, Hofstra, East Garden City, NY, US)

Chapter 9. Mechanical Ventilation in Obesity
(Rohit Godbole, MD, and Catherine S. Sassoon, MD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA, US, and others)

Chapter 10. Prone Position in Severe Acute Respiratory Distress Syndrome: Key Topics and Impact
(Radhika Z. Reddy, MD, Department of Medicine, VA Long Beach Medical Center, Long Beach, CA, US)

Chapter 11. Ventilatory Management in Severe Hypoxemic Respiratory Failure (Protective Ventilation Mode, Prone Position and Extracorporeal Oxygenation)
(Carmen Silvia Valente Barbas, MD, PhD, Roberta Fittipaldi Palazzo, MD, and Gustavo Faissol Janot de Matos, MD, PhD, Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil, and others)

Chapter 12. Extracorporeal Membrane Oxygenation (ECMO)
(Luca Salvatore De Santo, MD, Giovanni Cerullo, MD, and Carlo Zebele, MD, Chair of Cardiac Surgery, University of Foggia, Foggia, Italy, and others)

Chapter 13. Mechanical Ventilation in Cardiac Surgery
(P. Bhaskar Rao, MD, Neha Singh, MD and Rahul Dutta, MD, Department of Anaesthesiology and Critical care, All India institute of medical sciences, Bhubaneswar, India and Department of Cardiac Anaesthesiology, Max Super Specialty Hospital, New Delhi, India)

Chapter 14. Mechanical Ventilation Approach in Lung/Cardiac Transplants
(Schizas Nikolaos, MD, Lazopoulos Achilleas, MD, Krimiotis Dimitrios, MD, and Dimitrios Paliouras, MD, PhD)

Chapter 15. Mechanical Ventilation Approach: Thoracic Trauma
(Dimitris Krimiotis, MD, Achilleas Lazopoulos, MD, Thomas Rallis, MD, and Nikolaos Barbetakis, MD, PhD, Department of Thoracic Surgery, Cancer Hospital “Theageneio”, Thessaloniki, Greece)

Chapter 16. Mechanical Ventilation in Brain Damage
(George Gavriilidis, MD, Maria Daganou, MD, PhD, and Antonia Koutsoukou, MD, PhD, ICU, 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens Medical School, “Sotiria” Hospital, Athens, Greece)

Chapter 17. Mechanical Ventilation Approach in Pregnancy
(Jonathan Messika, MD, PhD, Service de Réanimation Médico-Chirurgicale, APHP, Hôpital Louis Mourier, Colombes, France, and others)

Chapter 18. Mechanical Ventilation Approach in Sleep Breathing Disorders
(Alexandra C. Gavala.MD, PhD, and Pavlos M. Myrianthefs, MD, PhD, ICU at Agioi Anargyroi Hospital, Nea Kifissia, Greece, and others)

Chapter 19. Mechanical Ventilation: Key Protocols and Recommendations for Agitation and Delirium
(Marcin Karcz, MD, and Peter Papadakos, MD, Columbia University Medical Center, New York, NY, US, and others)

Chapter 20. Mechanical Ventilation: Sedation, Neuromuscular Interactions, and the Impact on Outcome and Protocols
(Thomas Rallis MD, Nikolaos Schizas MD, Achilleas Lazopoulos MD, and Dimitrios Paliouras MD, PhD, “Theageneio” Anticancer Hospital, Thessaloniki, Greece)

Chapter 21. Monitoring Mechanical Ventilation – Respiratory Muscle Function: Use of Oesophageal Pressure and Electromyography of Respiratory Muscles during Mechanical Ventilation and Weaning
(Esther I Schwarz, MD, and Joerg Steier, MD PhD, Lane Fox Respiratory Unit and Sleep Disorders Centre, Guy’s & St Thomas‘ Hospital NHS Foundation Trust, London, UK, and others)

Chapter 22. Monitoring Diaphragm and Lung Function by Ultrasound
(Tenza-Lozano Eva, PhD, Intensive Care Unit, Hospital General Universitario Elche, Alicante, Spain)

Chapter 23. Measures by Electrical Impedance Tomography
(Marta Lazzeri, MD, Cecilia Turrini, MD, and Spadaro Savino, PhD, MD, Department of Morphology, Surgery and Experimental Medicine, Anesthesia and Intensive Care, University of Ferrara, Italy)

Chapter 24. Patient-Ventilator Interaction: Diagnosis and Treatment Options
(Fotis Yerosimou, MD, Achilles Lazopoulos, MD, Dimitris Paliouras, MD, PhD, Nikolaos Barbetakis, MD, PhD, Department of Anesthesiology, Department of Thoracic Surgery, Cancer Hospital “Theageneio”, Thessaloniki, Greece)

Chapter 25. Identifying Weaning Candidates: Screening and Spontaneous Breathing Trials
(Karen E. A. Burns, MD, Bram Rochwerg, MD, St. Michael’s Hospital, Toronto, Ontario Canada, and others)

Chapter 26. Liberation from Mechanical Ventilation (Ventilatory Options, Protocols) and Reintubation: Rehabilitation and Mobilization
(Guido Vagheggini, Alessandro Tani, Azienda USL Toscana Nordovest, Auxilium Vitae Weaning and Pulmonary Rehabilitation Unit, Volterra, Italy, and others)

Chapter 27. A Mechanical Ventilation Approach: Ventilator-Dependent Patients
(Capozzolo Alberto, MD, Carone Mauro, MD, and Aliani Maria, MD, Respiratory Division, ICS Maugeri S.P.A, Cassano Murge, BA, Italy)

Chapter 28. Goals-Directed Mobilization of Patients Receiving Mechanical Ventilation
(Giancarlo Garuti, MD, Maria Adelaide Calderazzo, MD, Pulmonary Medicine Unit, S. Maria Bianca Hospital, Mirandola, MO, Italy, and others

Chapter 29. Discharge from the Hospital of Patients Receiving Long-Term Home Mechanical Ventilation
(Michalis Agrafiotis, MD, Evangelia Serasli, MD, PhD, Eleni Kerezidou, MD, and Venetia Tsara, MD, PhD, Department of Pulmonary Medicine, “Georgios Papanikolaou General Hospital of Thessaloniki, Exohi, Greece, and others)

Chapter 30. Mechanical Ventilation (Invasive and Non-Invasive Ventilation): Ethical and Palliative Issues
(Rodolfo Ferrari, MD, Emergency Department, University Hospital Sant’Orsola, Malpighi, Bologna, Italy)

Chapter 31. Mechanical Ventilation: Outcomes and Health Related-Costs
(Bahman Saatian, MD, and Julie H. Lyou, MD, Department of Medicine , UC Irvine, Irvine, California, US, and others)


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