The concept of liberation and extubation Weaning from mechanical ventilation refers to the transition period from total ventilatory support to spontaneous breathing. Approximately 70% of intubated mechanically ventilated patients are extubated after the first spontaneous breathing trial (SBT), either by…
Introduction Physiologic closed-loop controlled (PCLC) systems run the gamut from simple negative feedback controllers to fully automated control of airway pressure, tidal volume (V T ), minute ventilation (V E ), fraction of inspired oxygen (FiO 2 ), and positive…
Noninvasive ventilation is defined as the provision of ventilatory assistance to the lungs without an invasive artificial airway. Noninvasive ventilators consist of a variety of devices, including negative- and positive-pressure units. Until the early 1960s, negative-pressure ventilation in the form…
Clinical management of patients with acute respiratory failure is based on the concept that significant changes in respiratory mechanics, respiratory muscle performance, and control of breathing are the underlying mechanisms responsible for acute respiratory failure. The effects of mechanical ventilation…
Introduction Understanding physiology underpins the logical decisions of critical care practice. Although facts and knowledge of literature findings and recommendations for specific problems clearly help inform good management, bedrock principles of physiology and pathophysiology translate across patients; awareness of them…
This chapter reviews available neuroimaging methods and their application in the evaluation and management of the critically ill and injured. Imaging modalities Radiography Plain radiography plays a minor role in evaluating the neurologically ill or injured patient. Radiography is not…
Introduction Despite many advances made in its diagnosis and treatment, spinal cord injury (SCI) continues to present challenging critical care issues to be treated, both acutely and chronically. The injury undoubtedly results in substantial psychological and financial impact not only…
Introduction Traumatic brain injury (TBI) is a medical and social problem worldwide, with an estimated 10 million cases leading to hospitalization or death each year. Most TBIs are mild, and the incidence of TBI varies widely by ages and between…
Abnormal neuromuscular function may precipitate a patient’s admission to an intensive care unit (ICU) or it may develop because of another critical illness and its treatment. This chapter focuses primarily on respiratory failure caused by neuromuscular disease but also addresses…
Introduction The routine use of continuous electroencephalographic (cEEG) recordings in intensive care demonstrates that clinical seizures in critically ill patients, both with neurologic and nonneurologic conditions, are the tip of the iceberg regarding seizure frequency in this vulnerable population. Nonconvulsive…