Ebook Principles and practice of mechanical ventilation (3/E): Part 1

Principles and Practice
of Mechanical Ventilation


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Principles and Practice
of Mechanical Ventilation
Third Edition

Editor

Martin J. Tobin, MD

Professor of Medicine and Anesthesiology
Edward Hines, Jr., Veterans Administration Hospital and
Loyola University of Chicago Stritch School of Medicine
Editor emeritus, American Journal of Respiratory and Critical Care Medicine
Chicago, Illinois

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To Sareen, Damien, Kate, and Kieran


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CONTENTS

Contributors xi
Preface xxi

9. Pressure-Controlled and Inverse-Ratio
Ventilation 227
Marcelo B. P. Amato and John J. Marini

I

HISTORICAL BACKGROUND 1

10. Positive End-Expiratory Pressure 253

Paolo Navalesi and Salvatore Maurizio Maggiore

1. Historical Perspective on the Development
of Mechanical Ventilation 3

V

Gene L. Colice

II

PHYSICAL BASIS OF
MECHANICAL VENTILATION 43

2. Classification of Mechanical Ventilators
and Modes of Ventilation 45
Robert L. Chatburn

11. Airway Pressure Release Ventilation 305
Christian Putensen

12. Proportional-Assist Ventilation 315
Magdy Younes

13. Neurally Adjusted Ventilatory Assist 351

3. Basic Principles of Ventilator Design 65
Robert L. Chatburn and Eduardo Mireles-Cabodevila

III INDICATIONS 99

4. Indications for Mechanical Ventilation 101
Franco Laghi and Martin J. Tobin

IV CONVENTIONAL METHODS

OF VENTILATORY SUPPORT 137

5. Setting the Ventilator

ALTERNATIVE METHODS OF
VENTILATOR SUPPORT 303

139

Steven R. Holets and Rolf D. Hubmayr

6. Assist-Control Ventilation 159
Jordi Mancebo

7. Intermittent Mandatory Ventilation 175
Catherine S. Sassoon

Christer Sinderby and Jennifer C. Beck

14. Permissive Hypercapnia 377
John G. Laffey and Brian P. Kavanagh

15. Feedback Enhancements on Conventional
Ventilator Breaths 403
Neil MacIntyre and Richard D. Branson

VI NONINVASIVE METHODS

OF VENTILATOR SUPPORT 415

16. Negative-Pressure Ventilation 417
Antonio Corrado and Massimo Gorini

17. Noninvasive Respiratory Aids: Rocking Bed,
Pneumobelt, and Glossopharyngeal Breathing 435
Nicholas S. Hill

18. Noninvasive Positive-Pressure Ventilation 447
Nicholas S. Hill

8. Pressure-Support Ventilation 199
Laurent J. Brochard and Francois Lellouche

vii


viii

Contents

VII UNCONVENTIONAL METHODS

OF VENTILATOR SUPPORT 493

Ahmet Baydur

19. High-Frequency Ventilation 495

33. Chronic Ventilator Facilities 777

Alison B. Froese and Niall D. Ferguson

Stefano Nava and Michele Vitacca

20. Extracorporeal Life Support
for Cardiopulmonary Failure 517

34. Noninvasive Ventilation on a General Ward

Heidi J. Dalton and Pamela C. Garcia-Filion

21. Extracorporeal Carbon Dioxide Removal

32. Mechanical Ventilation
in Neuromuscular Disease 761

543

Antonio Pesenti, Luciano Gattinoni, and Michela Bombino

IX PHYSIOLOGIC EFFECT OF

MECHANICAL VENTILATION 803

22. Transtracheal Gas Insufflation, Transtracheal

Oxygen Therapy, Emergency Transtracheal
Ventilation 555

35. Effects of Mechanical Ventilation
on Control of Breathing 805

Umberto Lucangelo, Avi Nahum, and Lluis Blanch

Dimitris Georgopoulos

VIII VENTILATOR SUPPORT
IN SPECIFIC SETTINGS 571

36. Effect of Mechanical Ventilation
on Heart–Lung Interactions 821
Hernando Gomez and Michael R. Pinsky

23. Mechanical Ventilation in the
Neonatal and Pediatric Setting 573

37. Effect of Mechanical Ventilation
on Gas Exchange 851

Peter C. Rimensberger and Jürg Hammer

Roberto Rodriguez-Roisin and Antoni Ferrer

24. Mechanical Ventilation
during General Anesthesia 597
Paolo Pelosi, Claudia Brusasco, and Marcelo Gama de Abreu

X

ARTIFICIAL AIRWAYS
AND MANAGEMENT 869

25. Independent Lung Ventilation 629

38. Airway Management 871

David V. Tuxen

Aaron M. Joffe and Steven Deem

26. Mechanical Ventilation during Resuscitation 655

39. Complications of Translaryngeal Intubation

Holger Herff and Volker Wenzel

John L. Stauffer

27. Transport of the Ventilator-Supported Patient 669

40. Care of the Mechanically Ventilated
Patient with a Tracheotomy 941

Richard D. Branson, Phillip E. Mason, and Jay A. Johannigman

28. Home Mechanical Ventilation 683

John E. Heffner and David L. Hotchkin

Wolfram Windisch

29. Mechanical Ventilation in the Acute
Respiratory Distress Syndrome 699

COMPLICATIONS IN

XI VENTILATOR-SUPPORTED

PATIENTS 971

John J. Marini

30. Mechanical Ventilation for Severe Asthma 727

41. Complications Associated
with Mechanical Ventilation 973

James W. Leatherman

Karin A. Provost and Ali A. El-Solh

31. Mechanical Ventilation in Chronic
Obstructive Pulmonary Disease 741

42. Ventilator-Induced Lung Injury

Franco Laghi

793

Mark W. Elliott

995

Didier Dreyfuss, Nicolas de Prost, Jean-Damien Ricard,
and Georges Saumon

895


ix

Contents

43. Ventilator-Induced Diaphragmatic
Dysfunction 1025

56. Ventilator-Supported Speech 1281
Jeannette D. Hoit, Robert B. Banzett, and Robert Brown

Theodoros Vassilakopoulos

57. Sleep in the Ventilator-Supported Patient 1293
44. Barotrauma and Bronchopleural Fistula 1041

Patrick J. Hanly

Andrew M. Luks and David J. Pierson

58. Weaning from Mechanical Ventilation
45. Oxygen Toxicity 1065

1307

Martin J. Tobin and Amal Jubran

Robert F. Lodato

59. Extubation
46. Pneumonia in the Ventilator-Dependent
Patient 1091
Jean E. Chastre, Charles-Edouard Luyt, and Jean-Yves Fagon

47. Sinus Infections in the Ventilated Patient 1123
Jean-Jacques Rouby and Qin Lu

1353

Martin J. Tobin and Franco Laghi

XIV ADJUNCTIVE THERAPY 1373
60. Surfactant 1375
James F. Lewis and Valeria Puntorieri

EVALUATION AND MONITORING

XII OF VENTILATOR-SUPPORTED

PATIENTS 1137

48. Monitoring during Mechanical Ventilation 1139
Amal Jubran and Martin J. Tobin

61. Nitric Oxide as an Adjunct 1389
Klaus Lewandowski

62. Diaphragmatic Pacing 1405
Anthony F. DiMarco

63. Bronchodilator Therapy 1419

MANAGEMENT OF VENTILATORXIII SUPPORTED PATIENTS 1167
49. Prone Positioning in Acute
Respiratory Failure 1169
Luciano Gattinoni, Paolo Taccone, Daniele Mascheroni,
Franco Valenza, and Paolo Pelosi

50. Pain Control, Sedation, and
Neuromuscular Blockade 1183
John P. Kress and Jesse B. Hall

51. Humidification

Rajiv Dhand

64. Inhaled Antibiotic Therapy 1447

Jean-Jacques Rouby, Ivan Goldstein, and Qin Lu

65. Fluid Management in the Ventilated Patient 1459
Andrew D. Bersten

XV ETHICS AND ECONOMICS 1471
66. The Ethics of Withholding and
Withdrawing Mechanical Ventilation 1473

1199

Jean-Damien Ricard and Didier Dreyfuss

Michael E. Wilson and Elie Azoulay

52. Airway Secretions and Suctioning 1213

67. Economics of Ventilator Care

Gianluigi Li Bassi

53. Fighting the Ventilator

1237

Martin J. Tobin, Amal Jubran, and Franco Laghi

54. Psychological Problems in the
Ventilated Patient 1259
Yoanna Skrobik

55. Addressing Respiratory Discomfort
in the Ventilated Patient 1267
Robert B. Banzett, Thomas Similowski, and Robert Brown

Shannon S. Carson

68. Long-Term Outcomes after
Mechanical Ventilation 1501
Margaret Sutherland Herridge

Index

1517

1489


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CONTRIBUTORS

Marcelo B. P. Amato, MD, PhD
Associate Professor
Pulmonary
University of São Paulo
São Paulo, SP, Brazil
Supervisor—Respiratory ICU
Chapter 9: Pressure-Controlled and Inverse-Ratio Ventilation

Elie Azoulay, MD, PhD
Hôpital Saint-Louis
Medical ICU
Université Paris-Diderot
Sorbonne Paris-Cité,
Faculté de médecine
Paris, France
Chapter 66: The Ethics of Withholding and Withdrawing
Mechanical Ventilation
Robert B. Banzett, PhD
Associate Professor
Department of Medicine
Harvard Medical School
Boston, Massachusetts
Division of Pulmonary, Critical Care, and Sleep Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts
Chapter 55: Addressing Respiratory Discomfort in
the Ventilated Patient
Chapter 56: Ventilator-Supported Speech
Ahmet Baydur, MD, FACP, FCCP
Professor of Clinical Medicine
Division of Pulmonary and Critical Care Medicine
Keck School of Medicine
University of Southern California
Los Angeles, California
Chapter 32: Mechanical Ventilation in Neuromuscular Disease
Jennifer C. Beck, PhD
Staff Scientist
Keenan Research Centre

Li Ka Shing Knowledge Institute of St. Michael’s Hospital
Toronto, Ontario, Canada
Assistant Professor
Pediatrics
University of Toronto
Toronto, Ontario, Canada
Chapter 13: Neurally Adjusted Ventilatory Assist

Andrew D. Bersten, MBBS, MD
Professor
Critical Care Medicine
Flinders University School of Medicine
Adelaide, South Australia
Director
ICCU
Flinders Medical Centre
Adelaide, South Australia
Chapter 65: Fluid Management in the Ventilated Patient
Lluis Blanch, MD, PhD
Senior
Critical Care Center
Hospital de Sabadell
Sabadell, Spain
Critical Care Center,
Hospital de Sabadell,
Corporació Sanitària Parc Taulí
Institut Universitari Fundació Parc Taulí-Universitat
Autònoma de Barcelona
Sabadell, Spain
CIBER Enfermedades Respiratorias—ISCIII, Spain

Chapter 22: Transtracheal Gas Insufflation, Transtracheal Oxygen
Therapy, Emergency Transtracheal Ventilation
Michela Bombino, MD
Staff Physician
Department of Perioperative Medicine and Intensive Care
A.O. Ospedale S. Gerardo
Monza, Italy
Chapter 21: Extracorporeal Carbon Dioxide Removal
Richard D. Branson, MSc, RRT
Professor
Surgery
University of Cincinnati
Cincinnati, Ohio
Adjunct Faculty
School of Aerospace Medicine
Wright Patterson Air Force Base
Dayton, Ohio
Chapter 15: Feedback Enhancements on Conventional
Ventilator Breaths
Chapter 27: Transport of the Ventilator-Supported Patient

xi


xii

Contributors

Laurent J. Brochard, MD
Professor

Department of Anesthesiology, Pharmacology,
Intensive Care Medicine
University of Geneva, School of Medicine
Geneva, Switzerland

Gene L. Colice, MD
Professor
Medicine
The George Washington University School of Medicine
Washington, District of Columbia

Head
Intensive Care Unit
Geneva University Hospital
Geneva, Switzerland
Chapter 8: Pressure-Support Ventilation

Director, Pulmonary, Critical Care and Respiratory Services
Medicine
Washington Hospital Center
Washington, District of Columbia
Chapter 1: Historical Perspective on the Development of
Mechanical Ventilation

Robert Brown, MD
Pulmonary and Critical Care Unit
Department of Medicine
Massachusetts General Hospital
Boston, Massachusetts

Antonio Corrado, MD
Unità di Terapia Intensiva Respiratoria-Fisiopatologia Toracica
Azienda Ospedaliera-Universitaria Careggi
Firenze, Italy
Chapter 16: Negative-Pressure Ventilation

Harvard Medical School
Boston, Massachusetts
Chapter 55: Addressing Respiratory Discomfort in
the Ventilated Patient
Chapter 56: Ventilator-Supported Speech
Claudia Brusasco, MD
Researcher
Department of Surgical Sciences and Integrated Diagnostics
University of Genova
Genova, Italy
Chapter 24: Mechanical Ventilation during General Anesthesia
Shannon S. Carson, MD
Associate Professor
Pulmonary and Critical Care Medicine
University of North Carolina School of Medicine
Chapel Hill, North Carolina
Chapter 67: Economics of Ventilator Care
Jean E. Chastre, MD
Professor of Medicine
Réanimation Médicale
University Pierre-et-Marie Curie, Paris 6
Paris, France
Head of Department
Réanimation Médicale

Hôpital Pitié-Salpêtrière
Paris, France
Chapter 46: Pneumonia in the Ventilator-Dependent Patient
Robert L. Chatburn, MHHS, RRT-NPS, FAARC
Professor
Medicine
Lerner College of Medicine of Case Western Reserve University
Clevelan, Ohio
Clinical Research Manager
Respiratory Institute
Cleveland Clinic
Cleveland, Ohio
Chapter 2: Classification of Mechanical Ventilators and
Modes of Ventilation
Chapter 3: Basic Principles of Ventilator Design

Heidi J. Dalton, MD, FCCM
Division and Section Chief, Critical Care Medicine
Director, ECMO
Phoenix Children’s Hospital
Phoenix, Arizona
Chapter 20: Extracorporeal Life Support for
Cardiopulmonary Failure
Nicolas de Prost, MD
Hôpitaux de Paris
Hôpital Henri Mondor
Service de Réanimation Médicale
Créteil, France
Chapter 42: Ventilator-Induced Lung Injury
Steven Deem, MD

Professor
Anesthesiology and Medicine
University of Washington
Seattle, Washington
Director, Neurocritical Care
Harborview Medical Center
Seattle, Washington
Chapter 38: Airway Management
Rajiv Dhand, MD, FCCP, FACP, FAARC
Professor
Medicine
University of Tennessee Graduate School of Medicine
Knoxville, Tennessee
Chairman
Medicine
University of Tennessee Graduate School of Medicine
Knoxville, Tennessee
Chapter 63: Bronchodilator Therapy


Contributors
Anthony F. DiMarco, MD
Professor
Department of Physiology & Biophysics
Case Western Reserve University
Cleveland, Ohio
Professor
MetroHealth Research Institute
MetroHealth Medical Center
Cleveland, Ohio

Chapter 62: Diaphragmatic Pacing
Didier Dreyfuss, MD
Professor
Department of Critical Care
Université Sorbonne Paris Cité and Hôpital Louis
Mourier, Colombes
Colombes, France
Chapter 42: Ventilator-Induced Lung Injury
Chapter 51: Humidification
Mark W. Elliott, MD, FRCP (UK)
Department of Respiratory Medicine
St James’s University Hospital
Leeds, West Yorkshire, United Kingdom
Chapter 34: Noninvasive Ventilation on a General Ward
Ali A. El-Solh, MD, MPH
Professor of Medicine, Anesthesiology, and Social and
Preventive Medicine
Department of Medicine
University at Buffalo
Buffalo, New York
Director of Critical Care
VA Western New York Healthcare System
Buffalo, New York
Chapter 41: Complications Associated with Mechanical Ventilation
Jean-Yves Fagon, MD, PhD
Professor
Critical Care
Hôpiotal Européen Georges Pompidou, AP-HP
and Paris Descarte University
Paris, France

Chapter 46: Pneumonia in the Ventilator-Dependent Patient
Niall D. Ferguson, MD, MSc
Associate Professor
Interdepartmental Division of Critical Care Medicine
University of Toronto
Toronto, Ontario, Canada
Director, Critical Care
Department of Medicine, Division of Respirology
University Health Network & Mount Sinai Hospital
Toronto, Ontario, Canada
Chapter 19: High-Frequency Ventilation

xiii

Antoni Ferrer, MD
Servei de Pneumologia
Hospital de Sabadell
Corporació Parc Taulí
Institut Universitari Fundació Parc Taulí
Universitat Autònoma de Barcelona
Sabadell, Spain
Chapter 37: Effect of Mechanical Ventilation on Gas Exchange
Alison B. Froese, MD, FRCP(C)
Professor
Departments of Anesthsiology and Perioperative Medicine,
Pediatrics, Physiology
Queen’s University
Kingston, Ontario, Canada
Attending Physician
Department of Anesthesiology and Perioperative Medicine

Kingston General Hospital
Kingston, Ontario, Canada
Chapter 19: High-Frequency Ventilation
Marcelo Gama de Abreu, MD, PhD, DESA
Professor of Anesthesiology and Intensive Care
Department of Anesthesiology and Intensive Care
University Hospital Carl Gustav Carus,
Dresden University of Technology
Dresden, Germany
Chapter 24: Mechanical Ventilation during General Anesthesia
Pamela C. Garcia-Filion, PhD, MPH
Research Scientist
Critical Care
Phoenix Children’s Hospital
Phoenix, Arizona
Chapter 20: Extracorporeal Life Support for Cardiopulmonary Failure
Luciano Gattinoni, MD
Full Professor
Dipartimento di Anestesiologia, Terapia Intensiva e Scienze
Dermatologiche
Fondazione IRCCS CaUniversità degli Studi di Milano
Milan, Italy
Dipartimento di Anestesia, Rianimazione e Terapia del Dolore
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
Milan, Italy
Chapter 21: Extracorporeal Carbon Dioxide Removal
Chapter 49: Prone Positioning in Acute Respiratory Failure
Dimitris Georgopoulos, MD, PhD
Professor
Intensive Care Medicine

University of Crete, Scool of Medine
Heraklion, Crete
Chapter 35: Effects of Mechanical Ventilation on
Control of Breathing


xiv

Contributors

Ivan Goldstein, MD, PhD
Réanimation Chirugicale Polyvalente Pierre Viars
Hôpital Pitié-Salpêtrière
Assistance Publique Hôpitaux de Paris
Université Pierre et Marie Curie
Paris, France
Chapter 64: Inhaled Antibiotic Therapy
Hernando Gomez, MD
Assistant Professor
Department of Critical Care Medicine
University of Pittsburgh Medical Center
Pittsburgh, Philadelphia
Chapter 36: Effect of Mechanical Ventilation on
Heart–Lung Interactions
Massimo Gorini, MD
Federico II University Hospital
School of Medicine
Naples, Italy
Chapter 16: Negative-Pressure Ventilation
Jesse B. Hall, MD

Section Chief
Professor of Medicine
Pulmonary and Critical Care
University of Chicago
Chicago, Illinois
Chapter 50: Pain Control, Sedation, and Neuromuscular Blockade
Jürg Hammer, MD
Associate Professor
Division of Intensive Care and Pulmonology
University Children’s Hospital Basel (UKBB)
Basel, Switzerland
Medical Director
Division of Intensive Care and Pulmonology
University Children’s Hospital Basel (UKBB)
Basel, Switzerland
Chapter 23: Mechanical Ventilation in the Neonatal
and Pediatric Setting
Patrick J. Hanly, MD, FRCPC, MRCPI, D, ABSM
Professor
Medicine
University of Calgary, Faculty of Medicine
Calgary, Alberta
Medical Director
Sleep Centre
Foothills Medical Centre
Calgary, Alberta
Chapter 57: Sleep in the Ventilator-Supported Patient

John E. Heffner, MD
Professor

Department of Medicine
Oregon Health & Science University
Portland, Oregon
Garnjobst Chair
Department of Medicine
Providence Portland Medical Center
Portland, Oregon
Chapter 40: Care of the Mechanically
Ventilated Patient with a Tracheotomy
Holger Herff, MD
Department of Anesthesiology and Critical Care Medicine
Innsbruck Medical University
Innsbruck, Austria
Chapter 26: Mechanical Ventilation during Resuscitation
Margaret Sutherland Herridge, MSc, MD, FRCPC, MPH
Associate Professor
Department of Medicine
University of Toronto
Toronto, Ontario, Canada
Attending Staff Critical Care and Respiratory Medicine
Department of Medicine
University Health Network
Toronto, Ontario, Canada
Chapter 68: Long-Term Outcomes after Mechanical Ventilation
Nicholas S. Hill, MD
Professor
Medicine
Tufts University School of Medicine
Boston, Massachussetts
Chief

Division of Pulmonary, Critical Care and Sleep Medicine
Tufts Medical Center
Boston, Massachussetts
Chapter 17: Noninvasive Respiratory Aids: Rocking Bed,
Pneumobelt, and Glossopharyngeal Breathing
Chapter 18: Noninvasive Positive-Pressure Ventilation
Jeannette D. Hoit, PhD, CCC-SLP
Professor
Department of Speech, Language, and Hearing Sciences
University of Arizona
Tucson, Arizona
Chapter 56: Ventilator-Supported Speech
Steven R. Holets, RRT
Assistant Professor of Anesthesiology
Department of Respiratory Care
Mayo Clinic
Rochester, Minnesota
Chapter 5: Setting the Ventilator


Contributors

xv

David L. Hotchkin, MD, MSc
Chief Pulmonary & Critical Care Medicine
Internal Medicine Residency Program
Providence Portland Medical Center
Portland, Oregon
Attending Physician

Division of Pulmonary, Critical Care and Sleep Medicine
The Oregon Clinic
Portland, Oregon
Chapter 40: Care of the Mechanically
Ventilated Patient with a Tracheotomy

John P. Kress, MD
Associate Professor
Department of Medicine, Section of Pulmonary and Critical Care
University of Chicago
Chicago, Illinois
Chapter 50: Pain Control, Sedation, and Neuromuscular Blockade

Rolf D. Hubmayr, MD
Professor
Department of Medicine
Mayo Clinic
Rochester, Minnesota
Chapter 5: Setting the Ventilator

Anesthetist-in-Chief
Department of Anestheisa
St Michael’s Hospital
Toronto, Ontario, Canada
Chapter 14: Permissive Hypercapnia

John G. Laffey, MD, MA, FCARCSI
Professor
Department of Anesthesia
University of Toronto Faculty of Medicine

Toronto, Ontario, Canada

Aaron M. Joffe, DO
Assistant Professor
Department of Anesthesiology and Pain Medicine
University of Washington, Harborview Medical Center
Seattle, Washington
Division Head of Otolaryngology, Oral and Maxillofacial
Anesthsia Services
University of Washington, Harborview Medical Center
Seattle, Washington
Chapter 38: Airway Management

Franco Laghi, MD
Professor
Division of Pulmonary and Critical Care Medicine
Edward Hines Jr. Veterans Affairs Hospital and Loyola University
of Chicago Stritch School of Medicine
Hines, Illinois
Chapter 4: Indications for Mechanical Ventilation
Chapter 31: Mechanical Ventilation in Chronic Obstructive
Pulmonary Disease
Chapter 53: Fighting the Ventilator
Chapter 59: Extubation

Jay A. Johannigman, MD
Professor
Department of Surgery
University of Cincinnati COM
Cincinnati, Ohio

Division Chief
Division of Trauma, Surgical Critical Care and Acute Care Surgery
University Hospital
Cincinnati, Ohio
Chapter 27: Transport of the Ventilator-Supported Patient

James W. Leatherman, MD
Professor
Medicine
University of Minnesota
Minneapolis, Minnesota
Director, Medical ICU
Pulmonary and Critical Care Medicine
Hennepin County Medical
Minneapolis, Minnesota
Chapter 30: Mechanical Ventilation for Severe Asthma

Amal Jubran, MD
Professor of Medicine
Division of Pulmonary and Critical Care Medicine
Edward Hines Jr., Veterans Affairs Hospital and Loyola University
of Chicago Stritch School of Medicine
Hines, Illinois
Chapter 48: Monitoring during Mechanical Ventilation
Chapter 53: Fighting the Ventilator
Chapter 58: Weaning from Mechanical Ventilation

Francois Lellouche, MD, PhD
Associante Professor
Medicine

Laval University
Québec, Québec
Critical Care Physician
Cardiac Surgery ICU
Institut Universitaire de Cardiologie et de Pneumologie de Québec
Québec, Québec
Chapter 8: Pressure-Support Ventilation

Brian P. Kavanagh, MB, FRCPC, FFARCSI (hon)
Professor & Chair
Department of Anesthesia
University of Toronto
Toronto, Canada
Staff Physician
Department of Critical Care Medicine
Hospital for Sick Children
Toronto, Canada
Chapter 14: Permissive Hypercapnia

Klaus Lewandowski, MD
Professor of Anesthesia and Intensive Care Medicine
Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie
Elisabeth-Krankenhaus Essen
Essen, Germany
Chapter 61: Nitric Oxide as an Adjunct


xvi

Contributors

James F. Lewis, MD, FRCP
Professor of Medicine and Physiology
Medicine
Western University
London, Ontario, Canada
Chapter 60: Surfactant
Gianluigi Li Bassi, MD
Attending Physician
Respiratory Intensive Care Unit
Hospital Clinic
Barcelona, Spain
Senior Researcher
Department of Pneumology
Institut d’investigacions Biomèdiques August Pi i Sunyer
Barcelona, Spain
Chapter 52: Airway Secretions and Suctioning
Robert F. Lodato, MD, PhD
Associate Professor
Division of Pulmonary, Critical Care, and Sleep Medicine
The University of Texas Health Science Center
Houston, Texas
Chapter 45: Oxygen Toxicity
Qin Lu, MD
Multidisciplinary Intensive Care Unit Pierre Viars
Department of Anesthesiology and Critical Care Medicine
La Pitié-Salpêtrière Hospital
Assistance Publique-Hôpitaux de Paris
Université Pierre et Marie Curie
Paris, France

Chapter 47: Sinus Infections in the Ventilated Patient
Chapter 64: Inhaled Antibiotic Therapy
Umberto Lucangelo, MD
Assistan Professor
Department of Perioperative Medicine,
Intensive Care and Emergency
University of Trieste School of Medicine
Trieste, Italy
Chapter 22: Transtracheal Gas Insufflation, Transtracheal Oxygen
Therapy, Emergency Transtracheal Ventilation
Andrew M. Luks, MD
Assistant Professor
Department of Medicine, Division of Pulmonary and
Critical Care Medicine
University of Washington
Seattle, Washington
Chapter 44: Barotrauma and Bronchopleural Fistula
Charles-Edouard Luyt, MD, PhD
Associate Professor
Medical Intensive Care Unit
Université Paris 6-Pierre et Marie Curie
Paris, France
Attending Physician
Medical Intensive Care Unit
Groupe Hospitalier Pitié-Salpêtrière, APHP
Paris, France
Chapter 46: Pneumonia in the Ventilator-Dependent Patient

Neil MacIntyre, MD
Professor

Medicine
Duke University
Durham, North Carolina
Chapter 15: Feedback Enhancements on Conventional
Ventilator Breaths
Salvatore Maurizio Maggiore, MD, PhD
Assistant Professor
Department of Anesthesiology and Intensive Care
Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore
Rome, Italy
Chapter 10: Positive End-Expiratory Pressure
Jordi Mancebo, MD
Director
Medicina Intensiva
Hospital de Sant Pau
Barcelona, Spain
Associate Professor
Medicine
Universitat Autònoma de Barcelona
Barcelona, Spain
Chapter 6: Assist-Control Ventilation
John J. Marini, MD
Professor of Medicine
Pulmonary & Critical Care
University of Minnesota
Minneapolis/St. Paul, Minnesota
Director of Physiologic & Translational Research
Dept. of Medicine
Regions Hospital
St. Paul, Minnesota

Chapter 9: Pressure-Controlled and Inverse-Ratio Ventilation
Chapter 29: Mechanical Ventilation in the Acute Respiratory
Distress Syndrome
Daniele Mascheroni, MD
Dipartimento di Anestesia, Rianimazione e Terapia del Dolore
FONDAZIONE IRCCS CA’ GRANDA,
Ospedale Maggiore Policlinico
Milano, Italy
Chapter 49: Prone Positioning in Acute Respiratory Failure
Phillip E. Mason, MD
Staff Physician
Department of Emergency Medicine
San Antonio Military Medical Center
San Antonio, Texas
Chapter 27: Transport of the Ventilator-Supported Patient
Eduardo Mireles-Cabodevila, MD
Assistant Professor
Division of Pulmonary and Critical Care
University of Arkasnas for Medical Sciences
Little Rock, Arizona
Director, Medical Intensive Care Unit
University of Arkasnas for Medical Sciences
Little Rock, Arizona
Chapter 3: Basic Principles of Ventilator Design


Contributors

xvii

Avi Nahum, MD, PhD
Associate Professor
Pulmonary and Critical Care Medicine
University of Minnesota
Minneapolis, Minnesota
Staff Physician
Department of Pulmonary and Critical Care
Regions Hospital
St. Paul, Minnesota
Chapter 22: Transtracheal Gas Insufflation, Transtracheal Oxygen
Therapy, Emergency Transtracheal Ventilation

Michael R. Pinsky, MD, Dr hc, FCCP, MCCM
Professor
Department of Critical Care Medicine
University of Pittsburgh
Pittsburgh, Philadelphia
Vice Chair for Academic Affairs
Department of Critical Care Medicine
University of Pittsburgh
Pittsburgh, Philadelphia
Chapter 36: Effect of Mechanical Ventilation on Heart–Lung
Interactions

Stefano Nava, MD
Chief
Respiratory and Critical Care
Sant’ Orsola Malpighi Hospital, University of Bologna
Bologna, Italy
Chapter 33: Chronic Ventilator Facilities

Karin A. Provost, DO, PhD
Research Assistant Professor
Division of Pulmonary, Critical Care and Sleep Medicine
State University of New York at Buffalo, School of Medicine and
Biomedical Sciences
Buffalo, New York
Chapter 41: Complications Associated with Mechanical Ventilation

Paolo Navalesi, MD
Associate Professor
Department of Translational Medine
Università del Piemonte Orientale “A. Avogadro”
Novara, Italy
Head
Anesthesia and Intensive Care
Ospedale Sant’Andrea
Vercelli, Italy
Chapter 10: Positive End-Expiratory Pressure
Paolo Pelosi, MD
Full Professor in Anesthesiology
Department of Surgical Sciences and Integrated Diagnostics
University of Genoa
Genoa, Italy
Chapter 24: Mechanical Ventilation during General Anesthesia
Chapter 49: Prone Positioning in Acute Respiratory Failure
Antonio Pesenti, MD
Professor
Department of Experimental Medicine
University of Milan Bicocca

Milan, Italy
Chief
Department of Emergency
San Gerardo Hospital
Monza, Italy
Chapter 21: Extracorporeal Carbon Dioxide Removal
David J. Pierson, MD
Professor Emeritus
Pulmonary and Critical Care Medicine
University of Washington School of Medicine
Seattle, Washington
Chapter 44: Barotrauma and Bronchopleural Fistula

Valeria Puntorieri, MD
University of Western Ontario
London, Ontario, Canada
Chapter 60: Surfactant
Christian Putensen, MD
Professor
Anesthesiology and Intensive Care Medicine
University Hospital Bonn
Bonn, Germany
Head of Intensive Care Medicine
Anesthesiology and Intensive Care Medicine
University Hospital Bonn
Bonn, Germany
Chapter 11: Airway Pressure Release Ventilation
Jean-Damien Ricard, MD, PhD
Professor
Service de Réanimation Médico-chirurgicale

Assistance Publique—Hôpitaux de Paris, Hopital Louis Mourier
Colombes, France
Researcher
UMR-S INSERM U722
Université Paris Diderot
Paris, France
Chapter 42: Ventilator-Induced Lung Injury
Chapter 51: Humidification
Peter C. Rimensberger, MD
Professor of Pediatrics and Intensive Care Medicine
Service of Neonatogy and Pediatric Intensive Care,
Department of Pediatrics
University Hospital of Geneva
Geneva, Switzerland
Director
Chapter 23: Mechanical Ventilation in the Neonatal
and Pediatric Setting


xviii

Contributors

Roberto Rodriguez-Roisin, MD, PhD
Full Professor of Medicine
Department of Medicine
Universitat de Barcelona
Barcelona, Spain
Senior Consultant Physician
Institute of Thorax-Servei de Pneumologia

Hospital Clínic
Barcelona, Spain
Chapter 37: Effect of Mechanical Ventilation on Gas Exchange

Yoanna Skrobik, MD FRCP(C)
Professor
Department of Medicine
Université de Montréal
Montréal, Québec, Canada
Lise and Jean Saine Critical Care Chair
Critical Care Division
Hopital Maisonneuve Rosemont
Montréal, Québec, Canada
Chapter 54: Psychological Problems in the Ventilated Patient

Jean-Jacques Rouby, MD, PhD
Professor of Anesthesiology and Critical Care
Department of Anesthesiology
Université Pierre et Marie Curie Paris 06
Paris, France
Chapter 47: Sinus Infections in the Ventilated Patient
Chapter 64: Inhaled Antibiotic Therapy

John L. Stauffer, MD
Senior Director
Clinical Development
FibroGen, Inc.
San Francisco, California
Physician/Consultant
Medical Service

Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto, California
Chapter 39: Complications of Translaryngeal Intubation

Catherine S. Sassoon, MD
Professor of Medicine
Division of Pulmonary and Critical Care Medicine
Department of Medicine
University of California School of Medicine
Irvine, California
Staff Physician
Department of Medicine
VA Long Beach Healthcare System
Long Beach, California
Chapter 7: Intermittent Mandatory Ventilation
Georges Saumon, MD
Institut National de la Santé et de la Recherche Médicale
Faculté Xavier Bichat
Paris, France
Chapter 42: Ventilator-Induced Lung Injury
Thomas Similowski, MD, PhD
Professor
Department of Respiratory and Critical Care Medicine
GH Pitié-Salpêtrière
Paris, France
Chapter 55: Addressing Respiratory Discomfort in
the Ventilated Patient
Christer Sinderby, MD
Staff Scientist

Critical Care
Li Ka Shing Knowledge Institute of the Keenan Research Center
at St-Michael’s Hospital
Toronto, Ontario, Canada
University of Toronto, Department of Medicine
Toronto, Ontario, Canada
Chapter 13: Neurally Adjusted Ventilatory Assist

Paolo Taccone, MD
Attending Physician
Dipartimento di Anestesia, Rianimazione (Intensiva e
Subintensiva) e Terapia del Dolore
Fondazione IRCCS Cà Granda—Ospedale Maggiore Policlinico
Milan, Italy
Chapter 49: Prone Positioning in Acute Respiratory Failure
Martin J. Tobin, MD
Professor of Medicine and Anesthesiology
Edward Hines, Jr., Veterans Administration Hospital and
Loyola University of Chicago Stritch School of Medicine
Editor emeritus, American Journal of Respiratory and
Critical Care Medicine
Chicago, Illinois
Chapter 4: Indications for Mechanical Ventilation
Chapter 48: Monitoring during Mechanical Ventilation
Chapter 53: Fighting the Ventilator
Chapter 58: Weaning from Mechanical Ventilation
Chapter 59: Extubation
David V. Tuxen, MBBS, FRACP, DipDHM, MD, CICM
Adjunct Professor
Department of Intensive Care

The Alfred Hospital
Melbourne, Australia
Senior Intensivist
Chapter 25: Independent Lung Ventilation


Contributors
Franco Valenza, MD
Assistant Professor
Dipartimento di Anestesia, Rianimazione e Scienze
Dermatologiche
Università degli Studi di Milano
Milano, Italy
Dipartimento di Anestesia e Rianimazione
Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico
Milano, Italy
Chapter 49: Prone Positioning in Acute Respiratory Failure
Theodoros Vassilakopoulos, MD
Associate Professor
1st Department of Critical Care and Pulmonary Services
University of Athens Medical School
Athens, Greece
Physician in Chief
Pulmonary Division/Critical Care Department
Evangelismos Hospital
Athens, Greece
Chapter 43: Ventilator-Induced Diaphragmatic Dysfunction
Michele Vitacca, MD
Rehabilitative Respiratory Division—Weaning Unit
Fondazione Salvatore Maugeri, IRCCS

Lumezzane, Brescia, Italy
Chapter 33: Chronic Ventilator Facilities

Volker Wenzel, MD, MSc, FERC
Associate Professor and Vice Chairman
Department of Anesthesiology and Critical Care Medicine
Innsbruck Medical University
Innsbruck, Austria
Chapter 26: Mechanical Ventilation during Resuscitation
Michael E. Wilson, MD
Instructor
Department of Internal Medicine
Mayo Clinic
Rochester, Minnesota
Chapter 66: The Ethics of Withholding and Withdrawing
Mechanical Ventilation
Wolfram Windisch, MD
Department of Pneumology
University Hospital Freiburg
Freiburg, Germany
Chapter 28: Home Mechanical Ventilation
Magdy Younes, MD, FRCP(C), PhD
Distinguished Professor Emeritus
Internal Medicine
University of Manitoba
Winnipeg, Manitoba, Canada
Research Professor
Department of Medicine
University of Calgary
Calgary, Alberta, Canada

Chapter 12: Proportional-Assist Ventilation

xix


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PREFACE

More than twenty years have passed since Principles and
Practice of Mechanical Ventilation was first conceived. With
this third edition, the textbook has come of age. When the
first proposal of the book was under consideration, reviewers thought that the corpus of knowledge pertaining to
mechanical ventilation would not be sufficient to merit the
publication of a large tome; they opined that the contents of
such a book would require much padding. This time around,
the challenge has been to fit everything into a constrained
number of pages. Virtually every aspect of mechanical ventilation has evolved substantially over the past twenty years,
and many new areas have emerged. Novel ventilator modes
have been introduced, previously discarded modes have acquired a new lease of life, and long-surviving methodologies have undergone considerable refinement. Much of the
progress has stemmed from research into the mechanisms
whereby ventilators harm patients. In turn, we have learned
how minor adjustments to ventilator settings can markedly
enhance patient comfort and survival. A comparison of the
third and first editions of Principles and Practice of Mechanical Ventilation provides proof of the tremendous progress in
this field during the past twenty years.
Trainees hear much about the practice of medicine, as in
phrases such as clinical practice guidelines. As physicians
grow older, they realize that many popular practices turn

out to be ephemeral—it is biomedical principles that remain
evergreen. Mechanical ventilation remains rooted in physiological principles; it is these principles that guide practice.
The wise physician is ever mindful of the need to balance
principles with practice—to achieve the right equilibrium
between theory and pragmatic action. Without a sound
knowledge of the biomedical principles that govern ventilator management, a physician is reduced to setting a ventilator
in a hit-or-miss manner or to follow a cookbook recipe. With
a deep understanding of physiologic principles, a physician
is better equipped to make expert iterative adjustments to the
ventilator as a patient’s condition changes over time. As with
previous editions, readers will find detailed accounts of both
biomedical principles and practical advice throughout this
textbook.
Electronic technology has transformed medical publishing, providing rapid access to a rich store of information.
Contrasted with the hours previously spent in the periodical rooms of a library, authors now retrieve pertinent arti-

cles at the click of a mouse. But reading material online is
not an unalloyed good. Deeply engaged reading requires
focused attention and commitment, whereas reading online
is accompanied by a dramatic increase in the opportunities
for distraction. Media do not simply act as passive channels
of communication, they also shape the process of thought.
Cognitive scientists have begun to uncover the differences
between reading online and off. Deep reading without distraction leads to the formation of rich mental connections
across regions of the brain that govern such cognitive functions as memory and interpretation. Neuroscientists expect
the internet to have far-reaching effects on cognition and
memory. In contrast to a book, which is a machine for focusing attention and demanding the deep thinking that generates memory, the internet is a machine that scatters attention
and diffuses concentration. Given the importance of rapid
decisions in critical care medicine, which demand instant
memory recall, a trainee is best advised to acquire the foundations for his or her storehouse of knowledge from a textbook rather than from online resources.

Another advantage of a textbook is that it provides a comprehensive account of a discipline in a single source, where
clinicians can turn to find answers to their questions about
mechanical ventilation. Commonly used online resources,
such as UpToDate, are directed toward generalists and do
not provide the depth of knowledge expected of a subspecialist. The information presented in medical journals is fragmentary by design; no attempt is made to fit published information into the mosaic of existing knowledge and topics
deemed unfashionable by editors are ignored. Trainees who
rely on bundles of reprints tend to be ignorant of the boundaries of a subspecialty and unaware of major lacunae in their
knowledge base. No series of journal articles can compete
with a textbook in this regard.
For a textbook to provide authoritative coverage of a field,
the selection of authors is crucial. For each chapter, I selected
scientists and clinicians who are at the forefront of research
in a given subfield. Many of these authors undertook the
seminal research that established a new area of mechanical
ventilation, which was subsequently enriched and expanded
by the work of other investigators. Being at the forefront
of  an area, these authors are attuned to evolving developments in a subfield, which makes their accounts extremely
current and guards against early obsolescence of the material

xxi


xxii

Preface

included in their chapter. Each chapter has been extensively
revised; twenty-five new authors provide fresh accounts of
previously covered areas; many new topics have been added;
and several chapters found in previous editions were deleted.

I personally edited every line of each manuscript to ensure
reliability of the presented information and to achieve a uniform style throughout the book.
Given that Principles and Practice of Mechanical Ventilation has become one of the classics on the McGraw-Hill list,
the publisher decided to introduce color printing throughout
the new edition. The result is a book that is not only informative but also aesthetically attractive. The large number of
high-quality illustrations provides a pedagogical resource for
readers who are preparing slides for lectures.

This book would not have been possible without the help
of several people, and to them I am extremely grateful. First
and foremost are the more than 100 authors, whose knowledge, commitment and wisdom form the core of the book.
As with the two previous editions, I am most grateful to
Amal Jubran and Franco Laghi for advice at several stages of
this project. I thank Lynnel Hodge for invaluable assistance
on a day-to-day basis. Richard Adin copyedited the manuscripts with a lawyer’s eye for precision, and Brain Belval and
Karen Edmondson at McGraw-Hill and Aakriti Kathuria at
Thomson Digital skillfully guided the book through its production. Finally, I thank my family for their forbearance.
Martin J. Tobin


I
HISTORICAL
BACKGROUND


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