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    Clinical application of mechanical ventilation / David W. Chang.

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    • Title:Clinical application of mechanical ventilation / David W. Chang.
    •    
    • Variant Title:Mechanical ventilation
    • Author/Creator:Chang, David W.
    • Published/Created:Clifton Park : Delmar, ©2014.

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    • Library of Congress Subjects:Respiratory therapy.
      Artificial respiration.
    • Medical Subjects: Respiration, Artificial.
    • Edition:4th ed.
    • Description:xxxi, 736 pages : illustrations ; 28 cm
    • Summary:Clinical application of mechanical ventilation, fourth edition integrates fundamental concepts of respiratory physiology with the day-to-day duties of a respiratory care professional. Utilizing the wide degree of topics covered, including airway management, understanding ventilator waveforms, and addressing critical care issues, readers have the best resource available for understanding mechanical ventilation and its clinical application. Enhancing the learning experience are valuable illustrations of concepts and equipment, highlighted key points, and self-assessment questions in NRBC format with answers. Whether preparing for the national exam or double-checking a respiratory care calculation, this book provides the fundamental principles of respiratory care with the clinical guidance necessary for mechanical ventilation. The book contains black-and-white illustrations.
    • Notes:"Delmar health care"--Cover.
      Includes bibliographical references and index.
    • ISBN:1111539588
      9781111539580
    • Contents:Principles Of Mechanical Ventilation:
      Introduction
      Airway resistance:
      Factors affecting airway resistance
      Airway resistance and the work of breathing
      Effects on ventilation and oxygenation
      Airflow resistance
      Lung compliance:
      Compliance measurement
      Static and dynamic compliance
      Compliance and the work of breathing
      Effects on ventilation and oxygenation
      Deadspace ventilation:
      Anatomic deadspace
      Alveolar deadspace
      Physiologic deadspace
      Ventilatory failure:
      Hypoventilation
      Ventilation/Perfusion (V/Q) mismatch
      Intrapulmonary shunting
      Diffusion defect
      Oxygenation failure:
      Hypoxemia and hypoxia
      Clinical conditions leading to mechanical ventilation:
      Depressed respiratory drive
      Excessive ventilatory workload
      Failure of ventilatory pump
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Effects Of Positive Pressure Ventilation:
      Introduction
      Pulmonary considerations:
      Spontaneous breathing
      Positive pressure ventilation
      Airway pressures
      Compliance
      Cardiovascular considerations:
      Mean airway pressure and cardiac output
      Decrease in cardiac output and O2 delivery
      Blood pressure changes
      Pulmonary blood flow and thoracic pump mechanism
      Hemodynamic considerations:
      Positive pressure ventilation
      Positive end-expiratory pressure
      Renal considerations:
      Renal perfusion
      Indicators of renal failure
      Effects of renal failure on drug clearance
      Hepatic considerations:
      PEEP and hepatic perfusion
      Indicators of liver dysfunction
      Effects of decreased hepatic perfusion on drug clearance
      Abdominal considerations:
      Effects of PEEP and increased intra-abdominal pressure
      Gastrointestinal considers
      Nutritional considerations:
      Muscle fatigue
      Diaphragmatic dysfunction
      Nutritional support
      Nutrition and the work of breathing
      Neurologic considerations:
      Hyperventilation
      Ventilatory and oxygenation failure
      Indicators of neurologic impairment
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Classification Of Mechanical Ventilators:
      Introduction
      Ventilator classification:
      Ventilatory work
      Input power
      Drive mechanism:
      Piston drive mechanism
      Bellows drive mechanism
      Microprocessor-controlled pneumatic drive mechanism
      Control circuit:
      Mechanical
      Pneumatic
      Fluidics
      Electronic
      Control variables:
      Pressure controller
      Volume controller
      Flow controller
      Time controller
      Phase variables:
      Trigger variable
      Limit variable
      Cycle variable
      Baseline variable
      Conditional variable
      Terminology of ventilation modes:
      Volume-controlled ventilation
      Pressure-controlled ventilation
      Intermittent Mandatory Ventilation (IMV)
      Pressure support
      Dual control within a breath
      Dual control breath-to-breath
      Pressure-limited time-cycled breaths
      Pressure-limited flow-cycled breaths
      Automode
      Proportional assist ventilation
      Automatic tube compensation
      Airway pressure release ventilation
      Output waveforms:
      Pressure waveforms
      Volume waveforms
      Flow waveforms
      Alarm systems:
      Input power alarms
      Control circuit alarms
      Output alarms
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Operating Modes OF Mechanical Ventilation:
      Introduction
      Negative and positive pressure ventilation:
      Negative pressure ventilation
      Positive pressure ventilation
      Operating modes of mechanical ventilation
      Closed-loop system
      Spontaneous:
      Apnea ventilation
      Positive End-Expiratory Pressure (PEEP):
      Indications of PEEP
      Physiology of PEEP
      Complications of PEEP
      Continuous positive Airway Pressure (CPAP)
      Bi-level Positive Airway Pressure (BiPAP):
      Indications for BiPAP
      Initial settings
      Adjustments of IPAP and EPAP
      Controlled Mandatory Ventilation (CMV)
      Indications of control mode
      Complications of control mode
      Assist/Control (AC):
      Assist control triggering mechanism
      Assist control cycling mechanism
      Indications for AC mode
      Advantages of AC mode
      Complications of AC mode
      Intermittent Mandatory Ventilation (IMV)
      Synchronized Intermittent Mandatory Ventilation (SIMV):
      SIMV mandatory breath-triggering mechanism
      SIMV spontaneous breath-triggering mechanism
      Indications of SIMV mode
      Advantages of SIMV mode
      Complications of SIMV mode
      Mandatory minute Ventilation (MMV)
      Pressure Support Ventilation (PSV):
      Indications for PSV mode
      Adaptive Support Ventilation (ASV)
      Proportional Assist Ventilation (PAV)
      Volume-Assured Pressure Support (VAPS)
      Pressure-Regulated Volume Control (PRVC):
      Automode
      Adaptive Pressure Control (APC)
      Volume Ventilation Plus (VV+):
      Volume Control Plus (VC+)
      Volume Support (VS)
      Pressure-Control Ventilation (PCV)
      Airway Pressure Release ventilation (APRV):
      Indications for APRV
      Biphasic Positive Airway Pressure (Biphasic PAP)
      Inverse Ratio Ventilation (IRV):
      Physiology or IRV
      Adverse effects of IRV
      Pressure Control-IRV (PC-IRV)
      Automatic Tube Compensation (ATC)
      Neurally Adjusted Ventilatory Assist (NAVA)
      High-Frequency Oscillatory Ventilation (HFOV)
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Special Airways For Ventilation:
      Introduction
      Oropharyngeal airway:
      Types of Oropharyngeal airways
      Selection of Oropharyngeal airway
      Insertion of Oropharyngeal airway
      Nasopharyngeal airway:
      Selection of Nasopharyngeal airway
      Insertion of Nasopharyngeal airway
      Complications of Nasopharyngeal airway
      Esophageal Obturator Airway (EOA):
      Insertion of EOA
      Esophageal Gastric Tube Airway (EGTA)
      Laryngeal Mask Airway (LMA):
      Use of LMA
      Contraindications for LMA
      Selection of LMA
      Insertion of LMA
      Removal of LMA
      Limitations of LMA
      Esophageal-Tracheal Combitube (ETC):
      Insertion and use of ETC
      Complications of ETC
      Double-Lumen Endobronchial Tube (DLT):
      Indications
      Selection of DLT
      Insertion of DLT
      Complications of DLT
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Airway Management In Mechanical Ventilation:
      Introduction
      Intubation:
      Indications
      Common artificial airways in mechanical ventilation:
      Endotracheal tube
      Tracheostomy tube
      Specialty tracheostomy devices
      Intubation procedure:
      Preintubation assessment and signs of difficult airway
      Supplies
      Special visualization devices
      Selection of endotracheal tube
      Ventilation and oxygenation
      Oral intubation
      Nasal intubation
      Common errors
      Signs of endotracheal intubation
      Signs of esophageal intubation
      Rapid sequence intubation:
      Indications and contraindications
      Practice guidelines
      Management of endotracheal and tracheostomy tubes:
      Securing endotracheal and tracheostomy tubes
      Cuff pressure
      Minimal occlusion volume and minimal leak technique
      Endotracheal suctioning
      Endotracheal tube changer
      Speaking valves:
      Contraindications
      Safety requirements
      Positive pressure ventilation
      Extubation:
      Predictors of successful extubation
      Procedure
      Unplanned extubation
      Complications of endotracheal airway:
      During intubation
      While intubated
      Immediately after extubation
      Following extubation
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Noninvasive Positive Pressure Ventilation:
      Introduction
      Terminology
      Physiologic effects of NPPV
      Use of Continuous Positive Airway Pressure (CPAP):
      Obstructive sleep apnea
      Use of Bi-level Positive Airway Pressure (Bi-level PAP)
      Common interfaces for CPAP and Bi-level PAP:
      Nasal mask
      Oronasal mask
      Nasal pillows
      Full-face mask
      Potential problems with interfaces
      Titration of continuous Positive Airway Pressure:
      Autotitration
      Ramp
      C-Flex
      Titration of Bi-level Positive Airway Pressures:
      Bi-Flex
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources. Initiation Of Mechanical Ventilation:
      Introduction
      Goals of mechanical ventilation
      Indications:
      Acute ventilatory failure
      Impending ventilatory failure
      Severe hypoxemia
      Prophylactic ventilatory support
      Contraindications
      Initial ventilator settings:
      Mode
      Dual control mode
      Frequency
      Tidal volume
      Pressure support
      F1O2
      PEEP
      I:E ratio
      Flow pattern
      Ventilator alarm settings:
      Low exhaled volume alarm
      Low inspiratory pressure alarm
      High inspiratory pressure alarm
      Apnea alarm
      High frequency alarm
      High and low F1O2 alarms
      Hazards and complications:
      Types of hazards and compilations
      Malfunction and misuses of alarms
      Barotrauma
      Decrease in cardiac output and blood pressure
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Monitoring In Mechanical Ventilation:
      Introduction
      Vital signs:
      Heart rate
      Blood pressure
      Respiratory frequency
      Temperature
      Chest inspection:
      Chest movement
      Auscultation
      Imaging
      Fluid balance and anion gap:
      Fluid balance
      Anion gap
      Arterial blood gases:
      Assessment of ventilatory status
      Assessment of oxygenation status
      Limitations of blood gases
      Oxygen saturation monitoring:
      Pulse oximetry
      Accuracy and clinical use of pulse oximetry
      Limitations of pulse oximetry
      Integrated pulse CO-Oximetry
      End-tidal carbon dioxide monitoring:
      Capnography
      Capnography waveforms and clinical application
      P(a-et)CO2 gradient
      Limitations of Capnography monitoring
      Transcutaneous blood gas monitoring:
      Transcutaneous PO2 (PtcO2)
      Transcutaneous PCO2 (PtcCO2)
      Cerebral perfusion pressure
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Hemodynamic Monitoring:
      Introduction
      Invasive hemodynamic monitoring:
      Technical background
      Units of measurement
      Types of catheters
      Arterial catheter:
      Insertion of arterial catheter
      Normal arterial pressure and mean arterial pressure
      Pulse pressure
      Potential problems with arterial catheter
      Central venous catheter:
      Insertion of central venous catheter
      Components of central venous pressure waveform
      CVP measurements
      Pulmonary artery catheter:
      Insertion of pulmonary artery catheter
      Components of pulmonary arterial pressure waveform
      PAP measurements
      Pulmonary capillary wedge pressure
      Components of pulmonary capillary edge pressure waveform
      PCWP measurements
      Verification of the wedged position
      Cardiac output and cardiac index
      Summary of preloads and afterloads
      Calculated hemodynamic values:
      Stroke volume and stroke volume index
      Oxygen consumption and oxygen consumption index
      Pulmonary vascular resistance
      Systemic vascular resistance
      Mixed venous oxygen saturation:
      Decrease in mixed venous oxygen saturation
      Increase in mixed venous oxygen saturation
      Less-invasive hemodynamic monitoring:
      Pulse contour analysis
      Noninvasive hemodynamic monitoring:
      Transesophageal echocardiography
      Carbon Dioxide Elimination (VCO2)
      Impedance cardiography:
      Theory of operation
      Thermodilution method and ICG
      Accuracy of ICG
      Clinical application
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Ventilator Waveform Analysis:
      Introduction
      Flow waveforms during positive pressure ventilation
      Effects of constant flow during volume-controlled ventilation:
      Flow-time waveform
      Pressure-time waveform
      Controlled mandatory ventilation
      Assist mandatory volume-controlled ventilation
      Mathematical analysis of constant-flow ventilation
      Spontaneous ventilation during mechanical ventilation:
      Synchronized intermittent mandatory ventilation
      Continuous positive airway pressure
      Effects of flow, circuit, and lung characteristics on pressure-time waveforms
      Flow and transairway pressure
      Compliance and alveolar pressure
      Effects of descending ramp flow waveform during volume-controlled ventilation:
      Time- and flow-limited ventilation
      Peak flow and tidal volume relationship in time-limited ventilation
      Effects of end-flow on end-transairway pressure
      Distribution of delivered tidal volume
      CMV during descending ramp flow ventilation
      Waveforms developed during pressure-controlled ventilation:
      Pressure-Controlled Ventilation (PCV)
      Assist breaths during pressure-controlled ventilation
      Inverse Ratio Pressure-Controlled Ventilation (IRPCV)
      Pressure support and spontaneous ventilation:
      Pressure Support Ventilation (PSV)
      Adjusting rise time during PSV
      SIMV (CFW) and PSV
      SIMV (DRFW) and PSV
      Effects of lung characteristics on pressure-controlled ventilation waveforms
      Using waveforms for patient-ventilator system assessment:
      Patient-ventilator dyssynchrony
      Dyssynchrony during constant flow ventilation
      Dyssynchrony during descending ramp flow ventilation
      Changes in pressure waveforms during respiratory mechanics measurement
      Dyssynchrony during pressure-controlled ventilation
      Using expiratory flow and pressure waveforms as diagnostic tools:
      Increased airway resistance
      Loss of elastic recoil
      Decreased lung-thorax compliance (Clt)
      Gas trapping and uncounted breathing efforts
      Troubleshooting ventilator function:
      Lack of ventilator response
      Circuit leaks
      Pressure-Volume Loop (PVL) and Flow-Volume Loop (FVL):
      Pressure-Volume Loop (PVL)
      Effects of lung-thorax compliance on PVL
      Effect of airflow resistance on PVL
      Lower inflection point on PVL and Titration of PEEP
      Upper inflection point on PVL and adjustment of Vt
      Effects of airway status on Flow-Volume Loop (FVL)
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Management Of Mechanical Ventilation:
      Introduction
      Basic management strategies
      Strategies to improve ventilation:
      Increase ventilator frequency
      Increase spontaneous tidal volume or frequency
      Increase ventilator tidal volume
      Other strategies to improve ventilation
      Permissive hypercapnia
      Strategies to improve oxygenation:
      Increase inspired oxygen fraction (F1O2)
      Improve ventilation and reduce mechanical deadspace
      Improve circulation
      Maintain normal hemoglobin level
      Initiate Continuous Positive Airway Pressure (CPAP)
      Initiate Positive End-Expiratory Pressure (PEEP)
      Initiate Inverse Ratio Ventilation (IRV)
      Initiate Extracorporeal Membrane Oxygenation (ECMO)
      Initiate High Frequency Oscillatory Ventilation (HFOV) for adults
      Arterial blood gases:
      Respiratory acidosis and compensated metabolic alkalosis
      Respiratory alkalosis and compensated metabolic acidosis
      Alveolar hyperventilation due to hypoxia, improper ventilator settings, or metabolic acidosis
      Alveolar hyperventilation in patients with COPD
      Alveolar hypoventilation due to sedation or patient fatigue
      Metabolic acid-base abnormalities
      Troubleshooting of common ventilator alarms and events:
      Low pressure alarm
      Low expired volume alarm
      High pressure alarm
      High frequency alarm
      Apnea/low frequency alarm
      High PEEP alarm
      Low PEEP alarm
      Auto-PEEP
      Care of the ventilator circuit:
      Circuit compliance
      Circuit patency
      Humidity and temperature
      Frequency of circuit change
      Care of the artificial airway:
      Patency of the endotracheal tube
      Humidification and removal of secretions
      Ventilator-associated pneumonia
      Fluid balance:
      Distribution of body water
      Clinical signs of extracellular fluid deficit or excess
      Treatment of extracellular fluid abnormalities
      Electrolyte balance:
      Normal electrolyte balance
      Sodium abnormalities
      Potassium abnormalities
      Nutrition:
      Under nutrition
      Overfeeding
      Low-carbohydrate high-fat diet
      Total caloric requirements
      Phosphate supplement
      Adjunctive management strategies:
      Low tidal volume
      Prone positioning
      Tracheal gas insufflation
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources. Pharmacotherapy For Mechanical Ventilation:
      Introduction
      Drugs for improving ventilation:
      Autonomic nervous system agents
      Adrenergic bronchodilators (Sympathomimetics)
      Anticholinergic bronchodilators (Parasympatholytics)
      Xanthine bronchodilators
      Anti-inflammatory agents (Corticosteroids)
      Delivery of MDI medications
      Neuromuscular blocking agents:
      Mechanism of action
      Characteristics of neuromuscular blocking agents
      Factors affecting neuromuscular blockade
      Factors affecting neuromuscular blockade
      Adverse effects
      Evaluation of neuromuscular blockade
      Central nervous system agents:
      Sedatives and antianxiety agents (Benzodiazepines)
      Opioid analgesics
      Agents for seizures and elevated intracranial pressure (Barbiturates)
      Other agents used in mechanical ventilation:
      Propofol
      Haloperidol
      Dexmedetomidine
      Nitric oxide
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Procedures Related To Mechanical Ventilation:
      Introduction
      Chest tube and drainage system:
      Indications for chest tube
      Chest tube selection and placement
      Methods of placement
      Chest tube drainage system
      Care and removal of chest tube
      Transport with chest tube
      Assisting in fiberoptic bronchoscopy:
      Indications for fiberoptic bronchoscopy
      Bronchoscope and medications
      Insertion of bronchoscope
      Types of specimen
      Complications
      Post bronchoscopy care
      Transport of mechanically ventilated patients:
      Indications
      Contraindications
      Equipment and supplies
      Types of transport
      Procedures for inter hospital transport
      Hazards and complications
      Magnetic resonance imaging
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Critical Care Issues In Mechanical Ventilation:
      Introduction
      Acute lung injury and acute respiratory distress syndrome
      Definitions of ALI and ARDS
      Pathophysiology
      Clinical presentations
      Lung protection using airway pressure thresholds
      Low tidal volume and permissive hypercapnia
      Decremental recruitment maneuver to determine optimal PEEP
      Prone positioning
      Ventilator-Associated Pneumonia (VAP):
      Incidence of VAP
      Clinical presentations
      Prevention of VAP
      Treatment of VAP
      Hypoxic-Ischemic Encephalopathy (HIE):
      General principles of HIE
      Cerebral perfusion pressure
      Decrease in CPP due to cardiac arrest
      Decrease in CPP due to shock
      Decrease in CPP due to brain injury
      Evaluation and treatment of HIE
      Trauma brain injury:
      Delayed brain injury
      Acceleration and deceleration brain injuries
      Clinical evaluation and assessment
      Management strategies
      Respiratory management
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Weaning From Mechanical Ventilation:
      Introduction
      Definition of weaning success and failure:
      Weaning success
      Weaning in progress
      Weaning failure
      Patient condition prior to weaning
      Weaning criteria:
      Ventilatory criteria
      Oxygenation criteria
      Pulmonary reserve
      Pulmonary measurements
      Rapid Shallow Breathing Index (RSBI)
      Weaning procedure:
      Spontaneous breathing trial
      Failure of SBT
      Pressure support ventilation
      Other modes of partial ventilatory support
      Weaning protocol
      Signs of weaning failure
      Causes of weaning failure:
      Increase of airflow resistance
      Decrease of compliance
      Respiratory muscle fatigue
      Terminal weaning:
      Prior to withdrawal
      Withdrawal
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Neonatal Mechanical Ventilation:
      Introduction
      Intubation:
      Indications
      Equipment
      Surfactant replacement therapy:
      History
      Indications
      Types of surfactant and dosages
      Outcomes
      Nasal CPAP:
      Use of nasal CPAP
      Basic principles of neonatal ventilation:
      Pressure-control ventilation
      Volume-controlled ventilation
      Ventilator circuits and humidifiers
      Initiation of neonatal ventilatory support:
      Indications for mechanical ventilation
      Initial ventilator settings
      High Frequency Ventilation (HFV):
      High Frequency Positive Pressure Ventilation (HFPPV)
      High Frequency Jet Ventilation (HFJV)
      High Frequency Oscillatory Ventilation (HFOV)
      Initial HFOV settings
      Other methods of ventilation:
      Machine volume
      Volume Guarantee
      Liquid ventilation
      Extracorporeal Membrane Oxygenation (ECMO):
      History
      Patient selection
      ECMO criteria
      Mechanisms of bypass
      Complications
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Mechanical Ventilation In Nontraditional Settings:
      Introduction
      Mechanical ventilation at home:
      Goals of Home Mechanical Ventilation (HMV)
      Indications and contraindications
      Patient selection
      Equipment selection
      Mechanical ventilation in mass casualty incidents:
      Causes of mass casualty
      Mass casualty and mechanical ventilation
      Triage systems for mass casualty incidents
      Strategic national stockpile
      Exclusion criteria for mechanical ventilation
      Personnel and planning
      Mechanical ventilation in hyperbaric condition:
      Rationale for Hyperbaric Oxygenation (HBO)
      Indications for HBO
      Endotracheal tube and ventilator
      Tidal volume fluctuations
      Monitoring and mechanical ventilation
      Defibrillation and cardiac pacing
      Mechanical ventilation in hypobaric condition:
      High-altitude cerebral and pulmonary edema
      Airplane cabin pressure
      Ventilator parameter changes under hypobaric conditions
      Pressure compensation
      Traveling with portable ventilators:
      Characteristics of portable ventilators
      Traveling in the United States
      Adjustment of tidal volume
      Portable oxygen concentrator
      Summary
      Self-assessment questions
      Answers to self-assessment questions
      References
      Additional resources
      Case Studies:
      Case 1: COPD
      Case 2: Status asthmaticus
      Case 3: Post-abdominal surgery
      Case 4: Head injury
      Case 5: Smoke inhalation
      Case 6: Drug overdose
      Case 7: Tension hemopneumothorax
      Case 8: Chest trauma
      Case 9: Acute respiratory distress syndrome
      Case 10: Myasthenia gravis
      Case 11: Guillain-Barre
      Case 12: Botulism
      Case 13: Meconium aspiration/patent ductus arteriosus
      Case 14: Persistent pulmonary hypertension of the newborn
      Case 15: Home care and disease management
      Case 16: End-of-life sedation on mechanical ventilation
      Appendix 1: Respiratory Care Calculations:
      A: Arterial oxygen tension to inspired oxygen concentration (PaO2/F1O2) index
      B: Cardiac Output (CO): Fick's estimated method
      C: Cerebral perfusion pressure
      D: Compliance: Dynamic (Cdyn)
      E: Compliance: Static (Cst)
      F: Corrected tidal volume (Vt)
      G: Deadspace to tidal volume Ratio (Vd/Vt)
      H: I:E Ratio
      I: Mean airway pressure (MPaw)
      J: Minute ventilation: expired and alveolar
      K: Oxygen content: arterial (CaO2)
      L: Oxygen index (OI)
      M: Shunt equation (Qsp/Qt): classic physiologic
      N: Shunt equation (Qsp/Qt): estimated
      O: Vascular resistance: pulmonary
      P: Vascular resistance: Systemic
      Q: Ventilator rate needed for a desired PaCO2
      R: Weaning index: rapid shallow breathing
      Appendix 2: Normal Electrolyte Concentrations in Plasma
      Appendix 3: Oxygen transport normal ranges
      Appendix 4: Hemodynamic normal ranges
      Appendix 5: Glasgow coma score
      Appendix 6: Apache II severity of disease classification system
      Glossary
      Index.
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