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Books on the topic 'Ventilation invasive'

Author: Grafiati
Published: 4 June 2021
Last updated: 1 February 2022

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1

Nava, Stefano, and Francesco Fanfulla. Non Invasive Artificial Ventilation. Milano: Springer Milan, 2014. http://dx.doi.org/10.1007/978-88-470-5526-1.

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2

Basner, Robert C., and Sairam Parthasarathy, eds. Nocturnal Non-Invasive Ventilation. Boston, MA: Springer US, 2015. http://dx.doi.org/10.1007/978-1-4899-7624-6.

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3

Christine, Mikelsons, ed. Non-invasive respiratory support techniques: Oxygen therapy, non-invasive ventilation, and CPAP. Chichester, West Sussex: Wiley-Blackwell, 2008.

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4

Rafferty, Mary Sara. A structural description of the experiences of individuals with severe Chronic Obstructive Pulmonary Disease using domiciliary non-invasive positive pressure ventilation. (s.l: The Author), 2001.

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5

Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0025.

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During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
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6

Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_001.

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During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
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7

Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_002.

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During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure and bilevel pressure support ventilation. Whereas non-invasive pressure support ventilation requires a ventilator, continuous positive airway pressure is a simpler technique that can be easily used in non-equipped areas such as the pre-hospital setting. The success of non-invasive ventilation is related to the adequate timing and selection of patients, as well as the appropriate use of interfaces, the synchrony of patient-ventilator, and the fine-tuning of the ventilator.
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8

Masip, Josep, Kenneth Planas, and Arantxa Mas. Non-invasive ventilation. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0025_update_003.

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During the last 25 years, the use of non-invasive ventilation has grown substantially. Non-invasive ventilation refers to the delivery of positive pressure to the lungs without endotracheal intubation and plays a significant role in the treatment of patients with acute respiratory failure and in the domiciliary management of some chronic respiratory and sleep disorders. In the intensive and acute care setting, the primary aim of non-invasive ventilation is to avoid intubation, and it is mainly used in patients with chronic obstructive pulmonary disease exacerbations, acute cardiogenic pulmonary oedema, immunocompromised or in the context of weaning, situations in which a reduction in mortality has been demonstrated. The principal techniques are continuous positive airway pressure, bilevel pressure support ventilation and more recently, high flow nasal cannula. Whereas non-invasive pressure support ventilation requires a ventilator, the other two techniques are simpler and can be easily used in non-equipped areas by less experienced teams, including the pre-hospital setting. The success of non-invasive ventilation is related to an adequate timing, proper selection of patients and interfaces, close monitoring as well as the achievement of a good adaptation to patients’ demand.
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9

Spoletini, Giulia, and Nicholas S. Hill. Non-invasive positive-pressure ventilation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0090.

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Non-invasive ventilation (NIV) has been increasingly used over the past decades to avoid endotracheal intubation (ETI) in critical care settings. In selected patients with acute respiratory failure, NIV improves the overall clinical status more rapidly than standard oxygen therapy, avoids ETI and its complications, reduces length of hospital stay, and improves survival. NIV is primarily indicated in respiratory failure due to acute exacerbations of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema and associated with immunocompromised states. Weaker evidence supports its use in other forms of acute hypercapnic and hypoxaemic respiratory failure. Candidates for NIV should be carefully selected taking into consideration the risk factors for NIV failure. Patients on NIV who are unstable or have risk factors for NIV failure should be monitored in an intensive or intermediate care units by experienced personnel to avoid delay when intubation is needed. Stable NIV patients can be monitored on regular wards.
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10

Elliott, Mark, Stefano Nava, and Bernd Schönhofer, eds. Non-Invasive Ventilation and Weaning. CRC Press, 2018. http://dx.doi.org/10.1201/9781315153643.

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11

Cutrera, Renato, and Brigitte Fauroux, eds. Pediatric Long-Term Non-Invasive Ventilation. Frontiers Media SA, 2021. http://dx.doi.org/10.3389/978-2-88966-648-5.

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12

Heunks, Leo, and Marcus J. Schultz, eds. ERS practical Handbook of Invasive Mechanical Ventilation. The European Respiratory Society, 2019. http://dx.doi.org/10.1183/9781849841221.eph01.

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13

Esmond, Glenda, and Christine Mikelsons. Non-Invasive Respiratory Support Techniques: Oxygen Therapy, Non-Invasive Ventilation and CPAP. Wiley & Sons, Incorporated, John, 2009.

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14

Kreit, John W. Noninvasive Mechanical Ventilation. Edited by John W. Kreit. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190670085.003.0016.

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Although so-called invasive ventilation can be life-saving, it can also cause significant morbidity. It has long been recognized that positive pressure ventilation can also be delivered “non-invasively” to critically ill patients through several different types of “interfaces” (usually a tight-fitting face mask). Noninvasive Mechanical Ventilation explains when and how to use noninvasive ventilation to treat patients with respiratory failure. It provides a detailed explanation of how noninvasive (bi-level) ventilators differ from the standard ICU ventilators, describes the available modes and breath types as well as the indications and contraindications for noninvasive ventilation, and explains how to initiate, monitor, and adjust noninvasive ventilation.
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15

Fanfulla, Francesco, and Stefano Nava. Non Invasive Artificial Ventilation: How, When and Why. Springer, 2013.

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16

Non Invasive Artificial Ventilation How When And Why. Springer Verlag, 2013.

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17

Elliott, Mark, Stefano Nava, and Bernd Schonhofer, eds. Non-invasive Ventilation and Weaning: Principles and Practice. CRC Press, 2010. http://dx.doi.org/10.1201/b13434.

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18

Ramsay, Michelle, and Mike Polkey. Non-invasive ventilation and chronic obstructive pulmonary disease. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199657742.003.0012.

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Non-invasive ventilation is one of the major advances in respiratory medicine over the last century. It can be lifesaving for patients in acute hypercapnic respiratory failure, improving gas exchange and pulmonary mechanics and reducing the need for endotracheal intubation. Adherence to therapy is key to its success, and many patients find this a significant challenge. This case report will examine the pitfalls of initiating non-invasive ventilation, provide a brief overview of the current British Thoracic Society non-invasive ventilation guidelines, and describe common causes of a chronic obstructive pulmonary disease patient ‘failing’ non-invasive ventilation and an approach to the long-term management of the frequently exacerbating chronic obstructive pulmonary disease patient.
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19

Lee, Jan Hau, and Ira M. Cheifetz. Respiratory Failure and Mechanical Ventilation. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199918027.003.0006.

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This chapter on respiratory failure and mechanical ventilation provides essential information about how to support children with severe respiratory disorders. The authors discuss multiple modes of respiratory support, including high-flow nasal cannula oxygen, noninvasive ventilation with continuous positive airway pressure and bilevel positive airway pressure, as well as conventional, high-frequency, and alternative modes of invasive ventilation. The section on invasive mechanical ventilation includes key information regarding gas exchange goals, modes of ventilation, patient–ventilator interactions, ventilator parameters (including tidal volume, end-expiratory pressure, and peak plateau pressure), extubation readiness testing, and troubleshooting. The authors also provide the new consensus definition of pediatric acute respiratory distress syndrome. Also included are multiple figures and indispensable information on adjunctive therapies (inhaled nitric oxide, surfactant, prone positioning, and corticosteroids) and respiratory monitoring (including capnography and airway graphics analysis).
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20

Wysocki. Mise en place de la ventilation non invasive en réanimation. Editions Masson, 2002.

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21

Dabo, Liu. Non-Invasive Positive Pressure Ventilation for Pediatric Sleep-Disordered Breathing. Nova Science Publishers, Incorporated, 2014.

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22

Esquinas, Antonio M. Mechanical Ventilators for Non-Invasive Ventilation: Principles of Technology and Science. Nova Science Publishers, Incorporated, 2020.

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23

Sharma, Sumit. Mechanical Ventilators for Non-Invasive Ventilation: Principles of Technology and Science. Nova Science Publishers, Incorporated, 2020.

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24

Nava, Stefano, and Luca Fasano. Ventilator Liberation Strategies. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0039.

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The weaning process should ideally begin as soon as the patient is intubated and continue through the treatment of the cause inducing acute respiratory failure. Weaning includes the assessment of readiness to extubate, extubation, and post-extubation monitoring; it also includes consideration of non-invasive ventilation which has been shown to reduce the duration of invasive mechanical ventilation in selected patients. Weaning accounts for approximately 40% of the total time spent on mechanical ventilation and should be achieved rapidly, since prolonged mechanical ventilation is associated with increased risk of complications and mortality and with increased costs. During mechanical ventilation, medical management should seek to correct the imbalance between respiratory load and ventilatory capacity (reducing the respiratory and cardiac workload, improving gas exchange and the ventilatory pump power). Ventilator settings delivering partial ventilatory pump support may help prevent ventilator-induced respiratory muscles dysfunction. Daily interruption of sedation has been associated with earlier extubation. Critically ill patients should be repeatedly and carefully screened for readiness to wean and readiness to extubate, and objective screening variables should be fully integrated in clinical decision making.
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25

Preiss, David Alan. A new method for the non-invasive measurement of cardiac output during spontaneous ventilation. 2005.

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26

Esquinas, Antonio M., ed. https://novapublishers.com/shop/mechanical-ventilators-for-non-invasive-ventilation-principles-of-technology-and-science/. Nova Science Publishers, 2020. http://dx.doi.org/10.52305/jsff1282.

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27

Non-Invasive Ventilation: A Practical Handbook for Understanding the Causes of Treatment Success and Failure. Nova Science Publishers, Incorporated, 2019.

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28

Dhand, Rajiv, and Michael McCormack. Bronchodilators in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0033.

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Inhaled beta-agonists and anticholinergic agents, as well as systemically administered methylxanthines, are frequently employed to achieve bronchodilation in critically-ill patients. Inhaled agents are given by pressurized metered dose inhaler (pMDI), nebulizer, or dry powder inhaler. In ventilator-supported patients, aerosolized agents are generally only administered by pMDI or nebulizer. The ventilator circuit, artificial airway, and circuit humidity complicate the delivery of aerosolized agents, and there is a wide variability in drug delivery efficiency with various bench models of mechanical ventilation. Aerosolized drug by pMDI is affected by the use of spacer devices, synchronization of pMDI actuation and ventilator breath delivery, and appropriate priming of the pMDI device. The efficiency of aerosolized drug delivery by jet nebulization is also affected by device placement in the circuit, as well as by a number of other factors. Several investigators have demonstrated comparable efficiency of aerosol delivery with mechanically-ventilated and ambulatory patients when careful attention is given to the technique of administration. Appropriate administration of aerosolized bronchodilators in patients receiving invasive or non-invasive positive pressure ventilation produces significant therapeutic effects.
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29

Fox, Grenville, Nicholas Hoque, and Timothy Watts. Respiratory support. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198703952.003.0008.

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This chapter includes sections on various modes of both invasive (i.e. via an endotracheal tube) and non-invasive respiratory support in neonates, including conventional ventilation, volume-targeted ventilation, high-frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), nasal continuous positive airways pressure (nCPAP), nasal intermittent positive pressure ventilation (nIPPV), and high and low-flow nasal cannula oxygen. There is also a brief section on the care of babies with a tracheostomy as well as management of babies requiring home oxygen. Reference is made to the most recent European Consensus Guidelines. A separate chapter on neonatal respiratory problems (Chapter 7) gives further detail on common lung pathologies requiring respiratory support in neonates.
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30

Evans, Charlotte, Anne Creaton, Marcus Kennedy, and Terry Martin, eds. Respiratory support. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198722168.003.0008.

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The aim of the respiratory support chapter is to provide the retrievalist with an armamentarium of information regarding advanced airway management. The chapter details the approach to the difficult airway with assessment tools and clinical features. Airway devices are discussed and intubation methods outlined. Practical guidance is provided on how to set up your non-invasive and invasive modes of ventilation with sections on mechanical ventilation of the healthy lung.
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31

Stacey, Victoria. Respiratory. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199592777.003.0010.

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Asthma - Chronic obstructive pulmonary disease (COPD) - Non-invasive ventilation - Venous thromboembolism - Pneumonia - Spontaneous pneumothorax - Respiratory failure and oxygen therapy - Arterial blood gas analysis - SAQs
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32

Li Bassi, Gianluigi, and Carles Agusti. Toilet bronchoscopy in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0122.

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Critically-ill patients retain respiratory secretions. Toilet bronchoscopy is applied to aspirate retained secretions and revert lung atelectasis. Toilet bronchoscopy is particularly indicated when retained secretions are visible during the procedureand air-bronchograms are not present at the chest radiograph. Yet, toilet bronchoscopy should only be applied when other less invasive methods of secretion removal have failed. Ventilatory settings during the intervention, the inspiratory fraction of oxygen should be increased to 100%. In volume control ventilation, the pressure limit alarm needs to be increased; during pressure-controlled ventilation, the set inspiratory pressure should be increased. The external PEEP should be decreased to at least 50% of the baseline values, to prevent barotrauma. The use of sedatives, analgesics, and topical anaesthetics is mandatory to achieve favourable procedural condition. Toilet bronchoscopy is also feasible and safe in critically-ill patients undergoing non-invasive ventilation.
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33

Glasper, Edward Alan, Gillian McEwing, and Jim Richardson, eds. High-dependency care. Oxford University Press, 2010. http://dx.doi.org/10.1093/med/9780198569572.003.0025.

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Assessing airway safety 788Assisting with tracheal tube intubation 790Insertion of a nasopharyngeal airway 792Assessing respiratory effectiveness 794Assessing perfusion 796Haemodynamic monitoring 798Methods of non-invasive respiratory support 800Invasive methods of respiratory support 802Care of the ventilated child 804Complications of intubation and ventilation ...
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34

Sampson, Brett G., and Andrew D. Bersten. Therapeutic approach to bronchospasm and asthma. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0111.

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The optimal management of bronchospasm and acute asthma is reliant upon confirmation of the diagnosis of asthma, detection of life-threatening complications, recognition of β‎2 agonist toxicity, and exclusion of important asthma mimics (such as vocal cord dysfunction and left ventricular failure). β‎2 agonists, anticholinergics, and corticosteroids are the mainstay of treatment. β‎2 agonists should be preferentially administered by metered dose inhaler via a spacer, and corticosteroids by the oral route, reserving nebulized (and intravenous) salbutamol, as well as intravenous hydrocortisone, for situations when these routes are not possible. A single intravenous dose of magnesium may be of benefit in severe asthma, but repeat dosing is likely to cause serious side effects. Parenteral administration of adrenaline may prevent the need for intubation in the patient in extremis. Aminophylline has an unfavourable side effect profile and has not been shown to offer additional benefit in adults. However, it does have a role in paediatric asthma. Unproven medical therapies with potential benefit include ketamine, heliox, inhalational anaesthetics, and leukotriene antagonists. The need for ventilatory support is usually preceded by worsening dynamic hyperinflation, exhaustion, hypoxia, reduced conscious state, or a combination of these. While non-invasive ventilation may have a temporizing role to allow time for response to medical therapy, there is insufficient evidence for its use, and should not delay invasive ventilation. If invasive ventilation is indicated, a strategy of hypoventilation and permissive hypercapnoea, minimizes barotrauma and dynamic hyperinflation. Extracorporeal support may have a role as a rescue therapy.
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35

Leaver, Susannah, and Timothy Evans. Hypoxaemia in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0085.

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Hypoxaemia is a reduction in the partial pressure of oxygen in the blood below 8 kPa/60 mmHg. Hypoxaemia results from one, or several, or a combination of causes. Calculating the alveolar–arterial gradient can help to delineate the cause. Acute respiratory failure manifests in a number of ways, the most sensitive indicator being an increased respiratory rate. Diagnosis is dependent on a comprehensive history, examination in combination with appropriate blood tests, and imaging. Hypoxaemia is the final common pathway of a number of conditions and the exact cause may not be immediately apparent. Despite this, the same management principles apply. A trial of non-invasive ventilation can be used to support patients during respiratory failure who do not require immediate endotracheal intubation. However, it is recommended that this is instituted for a preset trial period (e.g. 1–2 hours) in an HDU/ICU setting where facilities for definitive airway management are available. Invasive ventilation aims to facilitate treatment of the underlying condition whilst minimizing side effects through lung protective ventilatory strategies.
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36

Wagner, Beth. Withdrawal of Respiratory Technology. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190204709.003.0012.

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Respiratory failure can be defined as the inability of the lungs to provide adequate oxygenation or ventilation to sustain life. Respiratory failure can lead to abrupt clinical deterioration and is extremely distressing for patients and families. Advances in technology over the past decade have produced many life-sustaining therapies for patients with respiratory failure. Examples include high-flow oxygen therapy, invasive and noninvasive mechanically assisted breathing ventilation, prostacyclin therapy, and extracorporeal membrane oxygenation (ECMO). The care of these complex patients necessitates policies and procedures to assure quality care in withdrawal. Standardized protocols for withdrawal of life-sustaining respiratory therapies provide structured guidance, reduce variation in practice, and improve family and healthcare provider satisfaction.
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37

Frass, Michael. The difficult intubation in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0081.

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Airway management in the intensive care unit differs from conventional controlled settings such as general anaesthesia in the operating room (OR). Due to adequate patient preparation and positioning in the OR, endotracheal intubation is usually easy to perform. However, in the intensive care setting, endotracheal intubation is often difficult or impossible because patients are not prepared and intubation is immediately necessary without sufficient time for putting together technical and pharmaceutical equipment. As an alternative, non-invasive alternate airway management may be performed. Besides non-invasive ventilation via mask or helmet, the use of Combitube®, EasyTubeTM, and different types of laryngeal mask airway are described, in order to alleviate decision-making in emergency situations such as difficult intubation, vomiting and bleeding patients, small interincisor distance, etc.
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38

Oliver, David. End of life: Wishes, values and symptoms, and their impact on quality of life and well-being. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198757726.003.0013.

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The holistic assessment of the patient with ALS and their family will help to maximize the care as the disease progresses and the end of life approaches. This includes consideration of advance care planning, so that the person’s wishes are known if they lose capacity or communication late in the disease course. Discussion of ventilatory support, either by non-invasive ventilation or tracheostomy ventilation, is particularly important so that decisions are not made in a crisis situation. Although ventilatory support may improve quality of life (QoL) and length of survival, there may be increased dependency and continued disease progression. The recognition of the later stages of disease progression can allow further discussion and anticipation and preparation for end of life care—for patient, family, and professions—so that QoL is maximized until death.
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39

Fox, Grenville, Nicholas Hoque, and Timothy Watts. Respiratory problems. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198703952.003.0007.

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This chapter outlines the causes and initial management of respiratory distress in the newborn and gives a comprehensive description and guidelines for the management of common neonatal respiratory conditions such as surfactant deficiency lung disease, chronic lung disease of prematurity, and meconium aspiration syndrome. Congenital malformations of the respiratory system are detailed, including diaphragmatic hernia, and upper airway problems and obstruction. A separate chapter on neonatal respiratory support (Chapter 8) gives further detail on ventilation and non-invasive respiratory support.
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40

Herbert, Lara, and Bruce McCormick. Respiratory disease. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198719410.003.0005.

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This chapter describes the anaesthetic management of the patient with respiratory disease. It describes the assessment of respiratory function and preoperative respiratory investigations, and ventilatory strategies to reduce pulmonary complications. Common respiratory conditions covered include respiratory tract infection, smoking, asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea, sarcoidosis, restrictive pulmonary disease, and the patient with a transplanted lung. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. Recommendations for the patient who may require post-operative respiratory support (e.g. non-invasive ventilation) are provided.
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41

Herbert, Lara, and Bruce McCormick. Respiratory disease. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198719410.003.0005_update_001.

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This chapter describes the anaesthetic management of the patient with respiratory disease. It describes the assessment of respiratory function and preoperative respiratory investigations, and ventilatory strategies to reduce pulmonary complications. Common respiratory conditions covered include respiratory tract infection, smoking, asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea, sarcoidosis, restrictive pulmonary disease, and the patient with a transplanted lung. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. Recommendations for the patient who may require post-operative respiratory support (e.g. non-invasive ventilation) are provided.
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42

Macagno, Francesco, and Massimo Antonelli. Therapeutic strategy in acute or chronic airflow limitation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0112.

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The fragility of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accounts for their frequent hospitalization and their high intensive care unit risk. Therapy for AECOPD is varied and the need for hospitalization must be always carefully evaluated, considering the risk factors related to the presence of multi-resistant pathogens or the need of invasive procedures. The prolonged use of oxygen therapy requires an accurate monitoring of blood gases and continuous oximetry. Inhalation therapy can be performed using nebulizers, predosed aerosols or powders for inhalation. Corticosteroids for oral and systemic use now play an established role in AECOPD, because bacterial infections account for 50% of exacerbations. Non-invasive ventilation (NIV) must be considered the first option in AECOPD patients and acute respiratory failure if there are no contraindications. The careful monitoring of the patient and the response to NIV are indispensable elements for therapeutic success.
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43

Banerjee, Ashis, and Clara Oliver. Respiratory emergencies. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198786870.003.0010.

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Difficulty in breathing is both a common presenting complaint and a major acute presentation in the emergency department (ED). This chapter covers the common causes of breathlessness. It focuses on the management and diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in line with the British Thoracic Society guidelines, which may commonly appear as a short-answer question (SAQ). In addition, this chapter covers the pathophysiology of T2RF and its management, including the indications and contraindications for non-invasive ventilation. Another common topic examined in the SAQ paper is acid-base disturbances. This chapter includes a section on the indications and interpretation of arterial blood gas analysis.
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44

Innes, J. Alastair. Respiratory complications and management of severe CF lung disease. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780198702948.003.0006.

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This chapter covers the most common medical complications of severe CF lung disease, excluding the treatment of infection exacerbation. The section on haemoptysis covers severity assessment, medical and interventional radiological approaches to managing this problem. The particular risks of pneumothorax in CF are then discussed, including the factors guiding referral to surgery. The management of acute and chronic respiratory failure in CF is covered. This includes the indications for home oxygen and for non-invasive ventilation, and guidance on how these should be used in CF. Finally, there is a section on terminal care in cystic fibrosis, covering the management of the transition to palliative management at the end of life, and appropriate strategies to support patient and family in advanced disease.
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45

Hernandez, Michael R. Tracheoesophageal Fistula. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0017.

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Tracheoesophageal fistula (TEF) in the neonate is a complex congenital disorder that may occur in isolation or as part of a larger association of findings (i.e., VACTERL association). Care of these patients must include testing to clarify the anatomic and physiologic characteristics of each finding. This is particularly important for planning of surgical and anesthetic care. Surgical options for TEF repair vary in location of incision and also whether the approach is open or minimally invasive. Patients with severe congenital heart disease, such as hypoplastic left heart syndrome, pose unique challenges to the perioperative caregiver. The anesthesia team must balance the patient’s pulmonary and systemic blood flow while still heeding the need to avoid excessive ventilation via the TEF. Regional analgesia may provide the option of early extubation after TEF repair, but risks must be weighed against the patient’s anatomic and physiologic status.
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Scadding, Alys. Terminal care in respiratory illness. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0146.

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The terminal phase is the period of time between living with a reasonable quality of life, and the process of dying. While lung cancer and pulmonary fibrosis have the potential to deteriorate rapidly, the majority of lung diseases worsen over years. Every exacerbation of the condition leads to a decline in both lung function and performance status, and often the pre-exacerbation level of functioning is never regained. There is not a defining point to indicate whether a patient is entering the terminal stages of their illness, but practice shows that the following signs are suggestive: increasing breathlessness and thus becoming increasingly housebound; increasing oxygen requirements; declining pulmonary function test results; increasingly frequent exacerbations requiring hospital admission and/or non-invasive ventilation; developing cor pulmonale; weight loss and difficulty maintaining weight; anxiety and depression; if the death of the patient within the next year would not be a surprise.
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Lei, Yuan. Ventilator System Composition. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198784975.003.0005.

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‘Ventilator System Composition’ describes in depth, each of the six essential parts: the electrical supply, compressed gas supply, ventilator, breathing circuit, artificial airway, and the patient’s lungs. The chapter discusses the internal design of the ventilator, particularly the inspiratory channel and expiratory channel, and the use of a proportional valve. It describes the structure of the various breathing circuits or patient circuits that are used, and their relationship to the humidifier in use. Next, the author addresses the artificial airway or non-invasive patient interface, and finally the additional components that are added to the airway, components that add dead space and resistance to the circuit.
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Chan, Kin-Sang, Doris M. W. Tse, and Michael M. K. Sham. Dyspnoea and other respiratory symptoms in palliative care. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0082.

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Dyspnoea is prevalent among palliative care patients with increased severity over time. There are two patterns of dyspnoea-breakthrough dyspnoea and constant dyspnoea-and three separate qualities of dyspnoea-air hunger, work or effort, and tightness. The measurement of dyspnoea includes three domains: sensory-perceptual experience, affective distress, and symptom impact. The management of dyspnoea includes specific disease management, non-pharmacological intervention, pharmacological treatment, and palliative non-invasive ventilation. Cough is prevalent and disturbing in patients with cancer and chronic lung diseases, and is often associated with airway hypersecretion and impaired mucociliary clearance. Management includes specific treatments for underlying non-cancer and cancer-related causes, symptomatic treatment by antitussives, mucoactive agents, and airway clearance techniques for expectoration and reduction in mucus production. Anticholinergics may be indicated for death rattles to facilitate a peaceful death. Haemoptysis occurs in 30-60% of lung cancer patients and initial management of haemoptysis includes airway protection and volume resuscitation. Localization of the site and source of bleeding may determine the choice of treatment. If a life-threatening haemoptysis occurs, sedation should be given as soon as possible. Support should be given to the family, and debriefing provided to team members.
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Romagnoli, Stefano, and Giovanni Zagli. Blood pressure monitoring in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0131.

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Two major systems are available for measuring blood pressure (BP)—the indirect cuff method and direct arterial cannulation. In critically-ill patients admitted to the intensive care unit, the invasive blood pressure is the ‘gold standard’ as a tight control of BP values, and its change over time is important for choosing therapies and drugs titration. Since artefacts due to the inappropriate dynamic responses of the fluid-filled monitoring systems may lead to clinically relevant differences between actual and displayed pressure values, before considering the BP value shown as reliable, the critical care giver should carefully evaluate the presence/absence of artefacts (over- or under-damping/resonance). After the arterial pressure waveform quality has been verified, the observation of each component of the arterial wave (systolic upstroke, peak, systolic decline, small pulse of reflected pressure waves, dicrotic notch) may provide a number of useful haemodynamic information. In fact, changes in the arterial pulse contour are due the interaction between the heart beat and the whole vascular properties. Vasoconstriction, vasodilatation, shock states (cardiogenic, hypovolaemic, distributive, obstructive), valve diseases (aortic stenosis, aortic regurgitation), ventricular dysfunction, cardiac tamponade are associated with particular arterial waveform characteristics that may suggest to the physician underlying condition that could be necessary to investigate properly. Finally, the effects of positive-pressure mechanical ventilation on heart–lung interaction, may suggest the existence of an absolute or relative hypovolaemia by means of the so-called dynamic indices of fluid responsiveness.
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Wilson, A. P. R. Microbiological surveillance in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0281.

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Patients in the ICU are at high risk of acquiring multiresistant pathogens. Surveillance quickly identifies outbreaks and promotes antimicrobial stewardship. Catheter-related bacteraemia is often used as a performance measure and intervention using a package of preventative measures can be very successful. Ventilator-associated pneumonia in contrast can be difficult to define accurately. Water sources should be monitored. Pseudomonas aeruginosa may become established in taps and cause invasive infections especially in neonates. Screening of nasal swabs for MRSA followed by topical suppression has been effective in reducing spread during ICU admission. With rising prevalence of multiresistant Gram-negative species, screening of faeces or rectal swabs may become necessary. Acinetobacter is very disruptive if it causes an outbreak and it can be difficult to control. Screening is one method of limiting its’ spread. National surveillance networks are increasing and may be mandatory as they appear to be successful in controlling nosocomial infection.
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