Elsevier

Clinics in Chest Medicine

Volume 17, Issue 3, 1 September 1996, Pages 453-473
Clinics in Chest Medicine

MONITORING DURING MECHANICAL VENTILATION

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GAS EXCHANGE DURING MECHANICAL VENTILATION

The detrimental effects of hypoxemia have been recognized for centuries and dramatically summarized by Haldane who wrote, “anoxemia not only stops the machine but wrecks the machinery.” The adverse effect of hypoxemia on longevity was shown in long-term oxygen therapy trials, which showed that survival in patients who continuously had a Pa o2 below 55 mm Hg was decreased approximately 60% compared with patients who received oxygen therapy for most of the day. With the proliferation of pulse

Airway Occlusion Pressure

In routine critical care, respiratory center function rarely is measured at the bedside, although recent technologic developments have made it feasible. Measuring airway pressure 0.1 second after initiating an inspiratory effort against an occluded airway (P0.1) provides a measure of respiratory drive.113 Several investigators have examined the usefulness of P0.1 measurements in predicting a patient's ability to resume spontaneous ventilation following a period of mechanical ventilation. Three

Static Compliance

In a relaxed patient, effective static compliance of the total respiratory system (Crs,st) can be calculated as the volume delivered by the ventilator divided by the distending transthoracic pressure. Conditions of zero gas flow to permit measurement of Crs,st can be achieved by selecting the “inspiratory-hold” option on the ventilator or by occluding the expiratory port long enough to allow the airway pressure to reach a constant value (Fig. 9).13 The resulting plateau pressure represents the

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    Address reprint requests to Amal Jubran, MD, Division of Pulmonary and Critical Care Medicine, Veterans Administration Hospital, Route 111N, Hines, IL 60141

    This article is supported by a grant from the Veterans Administration Merit Review.

    All material in this article is in the public domain with the exception of any borrowed tables and figures.

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