Preface

xiii

Contributing Authors

xv

Reviewers

xix

SECTION I

RESPIRATORY ASSESSMENT

1

Chapter 1

History and Physical Examination   Priscilla Simmons

3

Creating a Therapeutic Climate

4

Components of the Health History

4

Vital Signs

5

Techniques of Assessment

5

Physical Examination of the Lungs and Thorax

6

Assessment of Other Body Systems

16

Chapter 2

Gas Exchange   Yuh-Chin T. Huang, Erika Lease, and will Beachey

21

Physiology of Gas Exchange

22

Assessment of Gas Exchange

34

Physiologic Mechanisms of Hypercapnia

38

Chapter 3

Acid-Base Balance   Yuh-Chin T. Huang, Erika Lease and will Beachey

41

Physiology of Acid-Base Balance

42

Definition of Acid and Base

42

Concept of pH

42

Buffer Solutions

43

Henderson-Hasselbalch Equation

44

Base Excess

44

Anion Gap

44

Strong Ion Difference

45

Regulation of pH

47

Erythrocytes and Acid-Base Control

47

Acid Production and Excretion

48

Acid-Base Disorders

50

Interpretive Strategies for Acid-Base Disorders

51

Chapter 4

Arterial Blood Gas Analysis and Sampling   Yuh-Chin T. Huang, Erika Lease, and will Beachey

55

History of Arterial Blood Gas Analysis

56

Blood Gas Analyzers

57

Blood Gas Sampling

59

Quality Control

64

Chapter 5

Respiratory Monitoring   Dean R. Hess

68

Pulse Oximetry

69

Capnography

75

Transcutaneous Blood Gas Monitoring

81

Respiratory Rate and Pattern

83

Chapter 6

Hemodynamic Monitoring   Joseph A. Govert and Dean R. Hess

87

Cardiac Rate and Rhythm

88

Arterial Blood Pressure

88

Central Venous Pressure Monitoring

91

Pulmonary Artery Catheters

92

Clinical Use’of Hemodynamic Measurements

98

Chapter 7

Cardiac Assessment   Jaspal Singh

101

Evaluation of Ventricular Function

102

Valvular Function

105

Coronary Artery Disease

107

Cardiac Conduction System

112

Chapter 8

Blood Chemistries and Hematology   Rafat O. Mohammed, Rajesh Bhagat, and Neil R. Maclntyre

126

Serum Electrolytes

127

Serum Chemistries Associated with Renal Function

133

Serum Enzyme Activity

133

Cardiac Enzymes and Proteins

134

Miscellaneous Serum Chemistries

135

Coagulation Tests

136

Hematology

137

Laboratory Standards and Quality Control

139

Chapter 9

Imaging the Thorax   Paolo Formenti, Vinko F. Tomicic, and Dean R. Hess

141

Density and Contrast

142

The Normal Chest Radiograph

142

Abnormalities Seen on Chest Radiographs

145

Cross-Sectional Imaging Techniques

151

Chapter 10

Pulmonary Function Testing   Ellen Cannefax and Paul Enright

157

Goals of Pulmonary Function Testing

158

Spirometry

158

Lung Volumes and Capacities

168

Diffusing Capacity

171

Specialized Pulmonary Function Tests

172

Chapter 11

Interventional Pulmonary Procedures   Women M. Wahidi and Scott L. Shofer

176

Diagnostic Bronchoscopy

177

Therapeutic Bronchoscopy

194

Airway Stenting

198

Pleural Disease

200

Future Directions

203

Chapter 12

Polysomnography   Bashir A. Chaudhary, Susan Whiddon, and Shelley C. Mishoe

207

Normal Sleep and Sleep Stages

208

Polysomnography Components

208

Scoring Criteria

213

Polysomnography Report

217

Chapter 13

Nutrition Assessment and Support   Charles D. McArthur

219

Effects of Nutrition on Respiratory Function

220

Nutrition Assessment

221

Calculation of Energy Requirements

222

Nutritional Support Guidelines

226

Chapter 14

Cardiopulmonary Exercise Assessment   Neil R. Maclntyre

231

Normal Cardiopulmonary Response to Exercise

232

Incremental Exercise Testing

233

Interpreting the Results of Incremental Cardiopulmonary Exercise Testing

236

Timed Walk Tests

237

Indications for Cardiopulmonary Exercise Testing

237

Safety Issues

240

SECTION II

RESPIRATORY THERAPEUTICS

243

Chapter 15

Therapeutic Gases: Manufacture, Storage, and Delivery   John Boatright and Jeffrey J. Ward

245

Chemical and Physical Properties of Therapeutic Gases

246

Therapeutic Gases in Respiratory Care

248

Storage and Distribution of Medical Gases

255

Chapter 16

Therapeutic Gases: Management and Administration   John Boatright and Jeffrey J. Ward

271

The Rationale for Supplemental Oxygen

272

Patient Conditions Commonly Warranting Oxygen Therapy

273

Limitations of Supplemental Oxygen

274

Complications and Hazards of Oxygen Therapy

274

Dosage Regulation and Administration Devices

277

Oxygen Administration Devices

280

Monitoring the Physiologic Effects of Oxygen

291

Clinical Application of Oxygen Therapy

292

Helium-Oxygen Therapy

294

Carbon Dioxide Therapy

297

Nitric Oxide Therapy

298

Chapter 17

Humidity and Aerosol Therapy   Dean R. Hess

303

Humidity

304

Normal Heat and Moisture Exchange

304

Goals of Humidity Therapy

305

Devices Used for Humidification

306

Bland Aerosol Therapy

312

Device Selection for Humidity Therapy

313

Aerosol Drug Administration

313

Aerosol Generators

315

Aerosol Delivery during Mechanical Ventilation

329

Aerosol Delivery by Tracheostomy

335

Selection of an Aerosol Delivery Device

336

Chapter 18

Sputum Collection, Airway Clearance, and Lung Expansion Therapy   Dean R. Hess

342

Normal Mechanisms of Mucociliary Transport

343

Sputum Collection

345

Airway Clearance

349

Lung Expansion Therapy

368

Chapter 19

Airway Management   John D. Davies, Robert A. May, And Pamela L Bortner

376

Oropharyngeal Airways

378

Masopharyngeal Airways

380

History of Intubation

381

Selection and Training of Personnel

381

Indications for Endotracheal Intubation

382

The Difficult Airway: Assessment and Strategy

383

Endotracheal Intubation

384

Tracheostomy

401

Tracheostomy Tubes

402

Airway Cuff Concerns

409

Airway Clearance

410

Chapter 20

Cardiopusmonary Resuscitation   Rhonda Bevis and Christine J. Moore

419

Cardiopulmonary Resuscitation

420

Basic Life Support

421

Advanced Cardiovascular Life Support

434

Ethical Concerns

440

Chapter 21

Mechanical Ventilators: Classification and Principles of Operation   Robert L. Chatburn and Teresa A. Votsko

444

Basic Concepts

445

Input Power

445

Power Transmission and Conversion

446

Control System

446

Control Variables

449

Phase Variables

450

Modes of Ventilation

454

Targeting Scheme

456

Output

457

Effects of the Patient Circuit

457

Ventilator Alarm Systems

459

Chapter 22

Mechanical Ventilation   Dean R. Hess and Neil R. Macintyre

462

The Equation of Motion

464

Indications for Mechanical Ventilation

464

Complications of Mechanical Ventilation

464

Ventilator Settings

467

Monitoring the Mechanically Ventilated Patient

482

Choosing Ventilator Settings for Different Forms of Respiratory Failure

490

Ventilatory Support Involves Trade-Offs

491

Liberation from Mechanical Ventilation

492

Chapter 23

Noninvastve Ventilation and Continuous Positive Airway Pressure   Dean R. Hess

501

Interfaces

502

Noninvasive Positive Pressure Ventilation

505

Continuous Positive Airway Pressure

512

Negative Pressure Ventilation, Rocking Beds, and Pneumobelts

517

Chapter 24

Neonatal and Pediatric Respiratory Care   Melissa K. Brown and Steven C. Mason

521

Neonatal Assessment

522

Oxygen Therapy

526

Mechanical Ventilation

527

Manual Ventilation

527

Airway Management

529

Nasal Continuous Positive Airway Pressure

531

Noninvasive Positive Pressure Ventilation

532

Conventional Infant and Pediatric Ventilation

532

High-Frequency Ventilation

538

Adjuncts to Neonatal and Pediatric Mechanical Ventilation

545

Chapter 25

Pulmonary Rehabilitation   Neil R. Maclntyre

549

Mechanisms of Functional Deterioration in Patients with Chronic Lung Disease

550

Program Structure

550

The Process of Pulmonary Rehabilitation

551

Outcomes from a Pulmonary Rehabilitation Program

555

Reimbursement Issues

556

Chapter 26

Home Respiratory Care   Angela King and Robert McCoy

559

Home Care Services

560

Goals of Home Care

560

The Medicare Program

560

Requirements for Home Medical Equipment Companies

561

The Respiratory Therapist as Home Care Provider

564

The Initial Home Visit

565

Bag Technique

566

Home Environment Evaluation

566

Long-Term Oxygen Therapy

569

Home Mechanical Ventilation

577

Chapter 27

Disaster Management   Richard D. Branson

589

History

590

The Threat

590

Planning for Mass Casualty Respiratory Failure

591

Ventilator Performance Characteristics

593

Ventilators for Mass Casualty Respiratory Failure

594

Triage

597

Chapter 28

Respiratory Care of the Elderly   Helen M. Sorenson

598

The Demography of Aging

599

Aging Pulmonary Anatomy and Physiology

600

Geriatric Patient Assessment

601

Atypical Disease Presentation

603

Geriatric Pharmacotherapy

605

Communicating with Older Adults

606

Pulmonary Disease after Age 65 Years

608

Chapter 29

Medical Information Management and Patient Safety   Thomas Malinowski I

615

Medical Information Management

616

Electronic Medical or Health Records

619

Appropriate Handling of Patient Information

620

Patient Safety

622

Safety Initiatives and Respiratory Care Applications

624

SECTION III

RESPIRATORY DISEASES

629

Chapter 30

Principles of Disease: Management   William F. Galvin

631

Forces Driving Disease Management

632

History and Evolution of Disease Management

633

Terms, Factors, and Concepts Associated with Disease Management

634

Goals of Disease Management

635

Basic Principles of Disease Management

636

Diseases Targeted for Disease Management Programs

638

Steps to Develop a Disease. Management Program

639

Barriers and Opportunities

640

Respiratory Therapists as Disease Managers

641

Chapter 31

Patient Education   William F. Galvin

643

Making the Case for Patient Education

644

Definition of Terms

645

Teaching and Learning Aspects of Patient Education

649

Indications and Goals in Patient Education

649

Process of Patient Education

649

Examples of Patient Education Programs

664

Chapter 32

Decision Making and the Role of Respiratory Therapists as Consultants   Shelley C. Mishoe and Laura H. Beverldge

678

The Evolving Role of Respiratory Therapists as Decision Makers and Consultants

679

Introduction to Guidelines, Protocols, and Pathways

680

Outcomes Evaluation and Evidence: What do the Data Show?

684

Consultation Skills for Healthcare Professionals

686

Respiratory Therapists as Healthcare Consultants

687

Chapter 33

Infection Control Principles   Donna D. Gardner

693

Transmission of Infection

694

Strategies for Infection Control

695

Regulatory Agencies

695

Cleaning, Disinfection, and Sterilization

695

Precautions

701

Healthcare-Associated Infections Related to Respiratory Care Equipment

708

Chapter 34

Asthma   Timothy R. Myers and Timothy Op’t Hott

710

Epidemiology

711

Pathophysiology

712

Pathogenesis

714

Risk Factors

714

Other Asthma Phenotypes

716

Disease Severity Classification

717

Assessing Control of Asthma

719

Objective Measurements

719

Pharmacologic Therapy

722

Aerosol Therapy

726

Adjunctive Treatments

727

Education

730

Chapter 35

Chronic Obstructive Pulmonary Disease   John E. Heffner

735

Burden of Chronic Obstructive Pulmonary Disease

736

Definitions and Staging of Disease

736

Etiology of Chronic Obstructive Pulmonary Disease

738

Pathophysiology of Chronic Obstructive Pulmonary Disease

739

Diagnosis and Clinical Course

742

Outpatient Care of Stable Chronic Obstructive Pulmonary Disease

743

Surgery

749

Overview of Management of Stable Chronic Obstructive Pulmonary Disease

752

Managing Exacerbations

752

Palliative and End-Of-Life Care

758

Chapter 36

Interstitial Lung Disease   Kathleen A. Short and Andrew J. Ghio

765

Pathophysiology

766

Classification

767

Clinical Presentation and Diagnostic Evaluation

768

Pathology

772

Prognosis

772

Management

772

Associated Diseases

773

Chapter 37

Puimonary Vascular Disease   C. William Hargett and Victor F. Tapson

779

Pathophysiology

780

Epidemiology

781

Diagnosis

782

Management of Selected Pulmonary Vascular Diseases

785

Chapter 38

Pneumonia   Bekefe Afessa

792

Definition and Classification of Pneumonia

793

Diagnostic Workup

794

Bacterial Causes of Pneumonia

797

Anaerobic Bacterial Infection

800

Viral Causes of Pneumonia

800

Mycobacterial Causes of Pneumonia

801

Fungal Respiratory Infections

803

Actinomycosis and Nocardiosis

804

Community-Acquired Pneumonia

805

Healthcare-Associated Pneumonia and Hospital-Acquired Pneumonia

810

Pneumonia in Immunocompromised Patients without HIV Infection

817

Pneumonia in Patients with HIV Infection

819

Pneumonia in Children

821

Chapter 39

Cystic Fibrosis   Teresa A. Volsko, Catherine O’Malley, Scott H. Donaldson, James R. Yankaskas, and Bruce K. Rubin

826

History

827

Pathogenesis

827

Diagnosis

829

Extrapulmonary Manifestations

830

Respiratory Manifestations

832

Major Respiratory Complications

834

Standard Therapy of Lung Disease

836

Chapter 40

Acute Lung Injury and the Acute Respiratory Distress Syndrome   Michael A. Gentile and Christopher E. Cox

845

Definition

846

Incidence

846

Etiology

846

Clinical Manifestations

847

Pathobiology

848

The National Institutes of Health ARDS Network

848

Management

848

Outcomes

852

Chapter 41

Postoperative Respiratory Care   Mark Simmons and Phscilla Simmons

856

Preoperative Assessment and Management

857

Preoperative Testing

859

Intraoperative Risk Factors

860

Postoperative Respiratory Failure: Assessment and Management

861

Atelectasis

862

Pulmonary Emboli and Pulmonary Thromboembolic Disease

864

Pneumonia

865

Mechanical Ventilation

865

Chapter 42

Cardiac Failure   William S. Stigler and Benjamin D. Medoff

868

Definition

869

Cardiac Physiology

869

Determinants of Ventricular Function

870

Pathophysiology of Cardiac Failure

872

Pathophysiology of Pulmonary Edema

875

Heart-Lung Interactions

876

Clinical Aspects of Cardiac Failure

878

Measurement and Monitoring of Cardiac Function

879

Treatment Guidelines for Chronic Cardiac Failure

881

Treatment Guidelines for Acute Cardiac Failure

883

Acute Myocardial Infarction

884

Ventilatory Support of the Patient with Cardiac Failure

884

Chapter 43

Trauma   Bryce R. H, Robinson and Richard D. Branson

890

The Primary and Secondary Surveys

891

Thoracic Trauma

891

Airway and Breathing Injuries

891

Circulation Injuries

893

Injuries Encountered during the Secondary Survey

895

Head Trauma

898

Primary Survey Issues of Head Injury

900

Secondary Survey Issues of Head Injury

900

Treatment of Head Injuries

901

Chapter 44

Burn and Inhalation Injury   Robert L. Sheridan and Daniel F. Fisher

904

Burn Injury

905

Inhalation Injury

909

Management of Inhalation Injury

911

Chapter 45

Neuromuscular Dysfunction   Francis C. Cordova, John Muilarkey, and Gerard J. Criner

919

Overview

920

Pathophysiology of Neuromuscular Disease on Respiratory Function

920

Evaluation of Respiratory Function in Patients with Neuromuscular Disease

926

Upper Motor Neuron Disorders

929

Lower Motor Neuron Disorders

933

Disorders of the Peripheral Nerves

935

Disorders of the Neuromuscular Junction

939

Inherited Myopathies

942

Acquired Inflammatory Myopathies

946

Treatment of Neuromuscular Dysfunction

947

Chapter 46

Obstructive Sleep Apnea   Basfiir A. Chaudhary, Arthur Taft, and Shelley C. Mishoe

956

Descriptions and Common Terms

957

Obstructive Sleep Apnea

959

Complications of Obstructive Sleep Apnea

961

Diagnosis of Obstructive Sleep Apnea

963

Treatment of Obstructive Sleep Apnea

963

Mortality Associated with Obstructive Sleep Apnea

968

Chapter 47

Lung Cancer   Maha Farhat

971

Classification

972

Epidemiology

974

Risk Factors and Etiology

974

Presentation

975

Solitary Pulmonary Nodule

978

Diagnosis

980

Workup and Staging

981

Treatment

983

Prognosis

985

Prevention

986

Future Directions

987

Chapter 48

Neonatal and Pediatric Respiratory Disorders   Sherry Barnhart

992

Apnea of Prematurity

993

Respiratory Distress Syndrome

994

Bronchopulmonary Dysplasia and Chronic Lung Disease

997

Transient Tachypnea of the Newborn