Clinical application of mechanical ventilation

Clinical application of mechanical ventilation, fourth edition integrates fundamental concepts of respiratory physiology with the day-to-day duties of a respiratory care professional. Utilizing the wide degree of topics covered, including airway management, understanding ventilator waveforms, and addressing critical care issues, readers have the best resource available for understanding mechanical ventilation and its clinical application. Enhancing the learning experience are valuable illustrations of concepts and equipment, highlighted key points, and self-assessment questions in NRBC format with answers. Whether preparing for the national exam or double-checking a respiratory care calculation, this book provides the fundamental principles of respiratory care with the clinical guidance necessary for mechanical ventilation. The book contains black-and-white illustrations

"Delmar health care"--Cover

Includes bibliographical references and index

Principles Of Mechanical Ventilation: -- Introduction -- Airway resistance: -- Factors affecting airway resistance -- Airway resistance and the work of breathing -- Effects on ventilation and oxygenation -- Airflow resistance -- Lung compliance: -- Compliance measurement -- Static and dynamic compliance -- Compliance and the work of breathing -- Effects on ventilation and oxygenation -- Deadspace ventilation: -- Anatomic deadspace -- Alveolar deadspace -- Physiologic deadspace -- Ventilatory failure: -- Hypoventilation -- Ventilation/Perfusion (V/Q) mismatch -- Intrapulmonary shunting -- Diffusion defect -- Oxygenation failure: -- Hypoxemia and hypoxia -- Clinical conditions leading to mechanical ventilation: -- Depressed respiratory drive -- Excessive ventilatory workload -- Failure of ventilatory pump -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Effects Of Positive Pressure Ventilation: -- Introduction -- Pulmonary considerations: -- Spontaneous breathing -- Positive pressure ventilation -- Airway pressures -- Compliance -- Cardiovascular considerations: -- Mean airway pressure and cardiac output -- Decrease in cardiac output and O2 delivery -- Blood pressure changes -- Pulmonary blood flow and thoracic pump mechanism -- Hemodynamic considerations: -- Positive pressure ventilation -- Positive end-expiratory pressure -- Renal considerations: -- Renal perfusion -- Indicators of renal failure -- Effects of renal failure on drug clearance -- Hepatic considerations: -- PEEP and hepatic perfusion -- Indicators of liver dysfunction -- Effects of decreased hepatic perfusion on drug clearance -- Abdominal considerations: -- Effects of PEEP and increased intra-abdominal pressure -- Gastrointestinal considers -- Nutritional considerations: -- Muscle fatigue -- Diaphragmatic dysfunction -- Nutritional support -- Nutrition and the work of breathing -- Neurologic considerations: -- Hyperventilation -- Ventilatory and oxygenation failure -- Indicators of neurologic impairment -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Classification Of Mechanical Ventilators: -- Introduction -- Ventilator classification: -- Ventilatory work -- Input power -- Drive mechanism: -- Piston drive mechanism -- Bellows drive mechanism -- Microprocessor-controlled pneumatic drive mechanism -- Control circuit: -- Mechanical -- Pneumatic -- Fluidics -- Electronic -- Control variables: -- Pressure controller -- Volume controller -- Flow controller -- Time controller -- Phase variables: -- Trigger variable -- Limit variable -- Cycle variable -- Baseline variable -- Conditional variable -- Terminology of ventilation modes: -- Volume-controlled ventilation -- Pressure-controlled ventilation -- Intermittent Mandatory Ventilation (IMV) -- Pressure support -- Dual control within a breath -- Dual control breath-to-breath -- Pressure-limited time-cycled breaths -- Pressure-limited flow-cycled breaths -- Automode -- Proportional assist ventilation -- Automatic tube compensation -- Airway pressure release ventilation -- Output waveforms: -- Pressure waveforms -- Volume waveforms -- Flow waveforms -- Alarm systems: -- Input power alarms -- Control circuit alarms -- Output alarms -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Operating Modes OF Mechanical Ventilation: -- Introduction -- Negative and positive pressure ventilation: -- Negative pressure ventilation -- Positive pressure ventilation -- Operating modes of mechanical ventilation -- Closed-loop system -- Spontaneous: -- Apnea ventilation -- Positive End-Expiratory Pressure (PEEP): -- Indications of PEEP -- Physiology of PEEP -- Complications of PEEP -- Continuous positive Airway Pressure (CPAP) -- Bi-level Positive Airway Pressure (BiPAP): -- Indications for BiPAP -- Initial settings -- Adjustments of IPAP and EPAP -- Controlled Mandatory Ventilation (CMV) -- Indications of control mode -- Complications of control mode -- Assist/Control (AC): -- Assist control triggering mechanism -- Assist control cycling mechanism -- Indications for AC mode -- Advantages of AC mode -- Complications of AC mode -- Intermittent Mandatory Ventilation (IMV) -- Synchronized Intermittent Mandatory Ventilation (SIMV): -- SIMV mandatory breath-triggering mechanism -- SIMV spontaneous breath-triggering mechanism -- Indications of SIMV mode -- Advantages of SIMV mode -- Complications of SIMV mode -- Mandatory minute Ventilation (MMV) -- Pressure Support Ventilation (PSV): -- Indications for PSV mode -- Adaptive Support Ventilation (ASV) -- Proportional Assist Ventilation (PAV) -- Volume-Assured Pressure Support (VAPS) -- Pressure-Regulated Volume Control (PRVC): -- Automode -- Adaptive Pressure Control (APC) -- Volume Ventilation Plus (VV+): -- Volume Control Plus (VC+) -- Volume Support (VS) -- Pressure-Control Ventilation (PCV) -- Airway Pressure Release ventilation (APRV): -- Indications for APRV -- Biphasic Positive Airway Pressure (Biphasic PAP) -- Inverse Ratio Ventilation (IRV): -- Physiology or IRV -- Adverse effects of IRV -- Pressure Control-IRV (PC-IRV) -- Automatic Tube Compensation (ATC) -- Neurally Adjusted Ventilatory Assist (NAVA) -- High-Frequency Oscillatory Ventilation (HFOV) -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Special Airways For Ventilation: -- Introduction -- Oropharyngeal airway: -- Types of Oropharyngeal airways -- Selection of Oropharyngeal airway -- Insertion of Oropharyngeal airway -- Nasopharyngeal airway: -- Selection of Nasopharyngeal airway -- Insertion of Nasopharyngeal airway -- Complications of Nasopharyngeal airway -- Esophageal Obturator Airway (EOA): -- Insertion of EOA -- Esophageal Gastric Tube Airway (EGTA) -- Laryngeal Mask Airway (LMA): -- Use of LMA -- Contraindications for LMA -- Selection of LMA -- Insertion of LMA -- Removal of LMA -- Limitations of LMA -- Esophageal-Tracheal Combitube (ETC): -- Insertion and use of ETC -- Complications of ETC -- Double-Lumen Endobronchial Tube (DLT): -- Indications -- Selection of DLT -- Insertion of DLT -- Complications of DLT -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Airway Management In Mechanical Ventilation: -- Introduction -- Intubation: -- Indications -- Common artificial airways in mechanical ventilation: -- Endotracheal tube -- Tracheostomy tube -- Specialty tracheostomy devices -- Intubation procedure: -- Preintubation assessment and signs of difficult airway -- Supplies -- Special visualization devices -- Selection of endotracheal tube -- Ventilation and oxygenation -- Oral intubation -- Nasal intubation -- Common errors -- Signs of endotracheal intubation -- Signs of esophageal intubation -- Rapid sequence intubation: -- Indications and contraindications -- Practice guidelines -- Management of endotracheal and tracheostomy tubes: -- Securing endotracheal and tracheostomy tubes -- Cuff pressure -- Minimal occlusion volume and minimal leak technique -- Endotracheal suctioning -- Endotracheal tube changer -- Speaking valves: -- Contraindications -- Safety requirements -- Positive pressure ventilation -- Extubation: -- Predictors of successful extubation -- Procedure -- Unplanned extubation -- Complications of endotracheal airway: -- During intubation -- While intubated -- Immediately after extubation -- Following extubation -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Noninvasive Positive Pressure Ventilation: -- Introduction -- Terminology -- Physiologic effects of NPPV -- Use of Continuous Positive Airway Pressure (CPAP): -- Obstructive sleep apnea -- Use of Bi-level Positive Airway Pressure (Bi-level PAP) -- Common interfaces for CPAP and Bi-level PAP: -- Nasal mask -- Oronasal mask -- Nasal pillows -- Full-face mask -- Potential problems with interfaces -- Titration of continuous Positive Airway Pressure: -- Autotitration -- Ramp -- C-Flex -- Titration of Bi-level Positive Airway Pressures: -- Bi-Flex -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources

Initiation Of Mechanical Ventilation: -- Introduction -- Goals of mechanical ventilation -- Indications: -- Acute ventilatory failure -- Impending ventilatory failure -- Severe hypoxemia -- Prophylactic ventilatory support -- Contraindications -- Initial ventilator settings: -- Mode -- Dual control mode -- Frequency -- Tidal volume -- Pressure support -- F1O2 -- PEEP -- I:E ratio -- Flow pattern -- Ventilator alarm settings: -- Low exhaled volume alarm -- Low inspiratory pressure alarm -- High inspiratory pressure alarm -- Apnea alarm -- High frequency alarm -- High and low F1O2 alarms -- Hazards and complications: -- Types of hazards and compilations -- Malfunction and misuses of alarms -- Barotrauma -- Decrease in cardiac output and blood pressure -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Monitoring In Mechanical Ventilation: -- Introduction -- Vital signs: -- Heart rate -- Blood pressure -- Respiratory frequency -- Temperature -- Chest inspection: -- Chest movement -- Auscultation -- Imaging -- Fluid balance and anion gap: -- Fluid balance -- Anion gap -- Arterial blood gases: -- Assessment of ventilatory status -- Assessment of oxygenation status -- Limitations of blood gases -- Oxygen saturation monitoring: -- Pulse oximetry -- Accuracy and clinical use of pulse oximetry -- Limitations of pulse oximetry -- Integrated pulse CO-Oximetry -- End-tidal carbon dioxide monitoring: -- Capnography -- Capnography waveforms and clinical application -- P(a-et)CO2 gradient -- Limitations of Capnography monitoring -- Transcutaneous blood gas monitoring: -- Transcutaneous PO2 (PtcO2) -- Transcutaneous PCO2 (PtcCO2) -- Cerebral perfusion pressure -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Hemodynamic Monitoring: -- Introduction -- Invasive hemodynamic monitoring: -- Technical background -- Units of measurement -- Types of catheters -- Arterial catheter: -- Insertion of arterial catheter -- Normal arterial pressure and mean arterial pressure -- Pulse pressure -- Potential problems with arterial catheter -- Central venous catheter: -- Insertion of central venous catheter -- Components of central venous pressure waveform -- CVP measurements -- Pulmonary artery catheter: -- Insertion of pulmonary artery catheter -- Components of pulmonary arterial pressure waveform -- PAP measurements -- Pulmonary capillary wedge pressure -- Components of pulmonary capillary edge pressure waveform -- PCWP measurements -- Verification of the wedged position -- Cardiac output and cardiac index -- Summary of preloads and afterloads -- Calculated hemodynamic values: -- Stroke volume and stroke volume index -- Oxygen consumption and oxygen consumption index -- Pulmonary vascular resistance -- Systemic vascular resistance -- Mixed venous oxygen saturation: -- Decrease in mixed venous oxygen saturation -- Increase in mixed venous oxygen saturation -- Less-invasive hemodynamic monitoring: -- Pulse contour analysis -- Noninvasive hemodynamic monitoring: -- Transesophageal echocardiography -- Carbon Dioxide Elimination (VCO2) -- Impedance cardiography: -- Theory of operation -- Thermodilution method and ICG -- Accuracy of ICG -- Clinical application -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Ventilator Waveform Analysis: -- Introduction -- Flow waveforms during positive pressure ventilation -- Effects of constant flow during volume-controlled ventilation: -- Flow-time waveform -- Pressure-time waveform -- Controlled mandatory ventilation -- Assist mandatory volume-controlled ventilation -- Mathematical analysis of constant-flow ventilation -- Spontaneous ventilation during mechanical ventilation: -- Synchronized intermittent mandatory ventilation -- Continuous positive airway pressure -- Effects of flow, circuit, and lung characteristics on pressure-time waveforms -- Flow and transairway pressure -- Compliance and alveolar pressure -- Effects of descending ramp flow waveform during volume-controlled ventilation: -- Time- and flow-limited ventilation -- Peak flow and tidal volume relationship in time-limited ventilation -- Effects of end-flow on end-transairway pressure -- Distribution of delivered tidal volume -- CMV during descending ramp flow ventilation -- Waveforms developed during pressure-controlled ventilation: -- Pressure-Controlled Ventilation (PCV) -- Assist breaths during pressure-controlled ventilation -- Inverse Ratio Pressure-Controlled Ventilation (IRPCV) -- Pressure support and spontaneous ventilation: -- Pressure Support Ventilation (PSV) -- Adjusting rise time during PSV -- SIMV (CFW) and PSV -- SIMV (DRFW) and PSV -- Effects of lung characteristics on pressure-controlled ventilation waveforms -- Using waveforms for patient-ventilator system assessment: -- Patient-ventilator dyssynchrony -- Dyssynchrony during constant flow ventilation -- Dyssynchrony during descending ramp flow ventilation -- Changes in pressure waveforms during respiratory mechanics measurement -- Dyssynchrony during pressure-controlled ventilation -- Using expiratory flow and pressure waveforms as diagnostic tools: -- Increased airway resistance -- Loss of elastic recoil -- Decreased lung-thorax compliance (Clt) -- Gas trapping and uncounted breathing efforts -- Troubleshooting ventilator function: -- Lack of ventilator response -- Circuit leaks -- Pressure-Volume Loop (PVL) and Flow-Volume Loop (FVL): -- Pressure-Volume Loop (PVL) -- Effects of lung-thorax compliance on PVL -- Effect of airflow resistance on PVL -- Lower inflection point on PVL and Titration of PEEP -- Upper inflection point on PVL and adjustment of Vt -- Effects of airway status on Flow-Volume Loop (FVL) -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Management Of Mechanical Ventilation: -- Introduction -- Basic management strategies -- Strategies to improve ventilation: -- Increase ventilator frequency -- Increase spontaneous tidal volume or frequency -- Increase ventilator tidal volume -- Other strategies to improve ventilation -- Permissive hypercapnia -- Strategies to improve oxygenation: -- Increase inspired oxygen fraction (F1O2) -- Improve ventilation and reduce mechanical deadspace -- Improve circulation -- Maintain normal hemoglobin level -- Initiate Continuous Positive Airway Pressure (CPAP) -- Initiate Positive End-Expiratory Pressure (PEEP) -- Initiate Inverse Ratio Ventilation (IRV) -- Initiate Extracorporeal Membrane Oxygenation (ECMO) -- Initiate High Frequency Oscillatory Ventilation (HFOV) for adults -- Arterial blood gases: -- Respiratory acidosis and compensated metabolic alkalosis -- Respiratory alkalosis and compensated metabolic acidosis -- Alveolar hyperventilation due to hypoxia, improper ventilator settings, or metabolic acidosis -- Alveolar hyperventilation in patients with COPD -- Alveolar hypoventilation due to sedation or patient fatigue -- Metabolic acid-base abnormalities -- Troubleshooting of common ventilator alarms and events: -- Low pressure alarm -- Low expired volume alarm -- High pressure alarm -- High frequency alarm -- Apnea/low frequency alarm -- High PEEP alarm -- Low PEEP alarm -- Auto-PEEP -- Care of the ventilator circuit: -- Circuit compliance -- Circuit patency -- Humidity and temperature -- Frequency of circuit change -- Care of the artificial airway: -- Patency of the endotracheal tube -- Humidification and removal of secretions -- Ventilator-associated pneumonia -- Fluid balance: -- Distribution of body water -- Clinical signs of extracellular fluid deficit or excess -- Treatment of extracellular fluid abnormalities -- Electrolyte balance: -- Normal electrolyte balance -- Sodium abnormalities -- Potassium abnormalities -- Nutrition: -- Under nutrition -- Overfeeding -- Low-carbohydrate high-fat diet -- Total caloric requirements -- Phosphate supplement -- Adjunctive management strategies: -- Low tidal volume -- Prone positioning -- Tracheal gas insufflation -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources

Pharmacotherapy For Mechanical Ventilation: -- Introduction -- Drugs for improving ventilation: -- Autonomic nervous system agents -- Adrenergic bronchodilators (Sympathomimetics) -- Anticholinergic bronchodilators (Parasympatholytics) -- Xanthine bronchodilators -- Anti-inflammatory agents (Corticosteroids) -- Delivery of MDI medications -- Neuromuscular blocking agents: -- Mechanism of action -- Characteristics of neuromuscular blocking agents -- Factors affecting neuromuscular blockade -- Factors affecting neuromuscular blockade -- Adverse effects -- Evaluation of neuromuscular blockade -- Central nervous system agents: -- Sedatives and antianxiety agents (Benzodiazepines) -- Opioid analgesics -- Agents for seizures and elevated intracranial pressure (Barbiturates) -- Other agents used in mechanical ventilation: -- Propofol -- Haloperidol -- Dexmedetomidine -- Nitric oxide -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Procedures Related To Mechanical Ventilation: -- Introduction -- Chest tube and drainage system: -- Indications for chest tube -- Chest tube selection and placement -- Methods of placement -- Chest tube drainage system -- Care and removal of chest tube -- Transport with chest tube -- Assisting in fiberoptic bronchoscopy: -- Indications for fiberoptic bronchoscopy -- Bronchoscope and medications -- Insertion of bronchoscope -- Types of specimen -- Complications -- Post bronchoscopy care -- Transport of mechanically ventilated patients: -- Indications -- Contraindications -- Equipment and supplies -- Types of transport -- Procedures for inter hospital transport -- Hazards and complications -- Magnetic resonance imaging -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Critical Care Issues In Mechanical Ventilation: -- Introduction -- Acute lung injury and acute respiratory distress syndrome -- Definitions of ALI and ARDS -- Pathophysiology -- Clinical presentations -- Lung protection using airway pressure thresholds -- Low tidal volume and permissive hypercapnia -- Decremental recruitment maneuver to determine optimal PEEP -- Prone positioning -- Ventilator-Associated Pneumonia (VAP): -- Incidence of VAP -- Clinical presentations -- Prevention of VAP -- Treatment of VAP -- Hypoxic-Ischemic Encephalopathy (HIE): -- General principles of HIE -- Cerebral perfusion pressure -- Decrease in CPP due to cardiac arrest -- Decrease in CPP due to shock -- Decrease in CPP due to brain injury -- Evaluation and treatment of HIE -- Trauma brain injury: -- Delayed brain injury -- Acceleration and deceleration brain injuries -- Clinical evaluation and assessment -- Management strategies -- Respiratory management -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Weaning From Mechanical Ventilation: -- Introduction -- Definition of weaning success and failure: -- Weaning success -- Weaning in progress -- Weaning failure -- Patient condition prior to weaning -- Weaning criteria: -- Ventilatory criteria -- Oxygenation criteria -- Pulmonary reserve -- Pulmonary measurements -- Rapid Shallow Breathing Index (RSBI) -- Weaning procedure: -- Spontaneous breathing trial -- Failure of SBT -- Pressure support ventilation -- Other modes of partial ventilatory support -- Weaning protocol -- Signs of weaning failure -- Causes of weaning failure: -- Increase of airflow resistance -- Decrease of compliance -- Respiratory muscle fatigue -- Terminal weaning: -- Prior to withdrawal -- Withdrawal -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Neonatal Mechanical Ventilation: -- Introduction -- Intubation: -- Indications -- Equipment -- Surfactant replacement therapy: -- History -- Indications -- Types of surfactant and dosages -- Outcomes -- Nasal CPAP: -- Use of nasal CPAP -- Basic principles of neonatal ventilation: -- Pressure-control ventilation -- Volume-controlled ventilation -- Ventilator circuits and humidifiers -- Initiation of neonatal ventilatory support: -- Indications for mechanical ventilation -- Initial ventilator settings -- High Frequency Ventilation (HFV): -- High Frequency Positive Pressure Ventilation (HFPPV) -- High Frequency Jet Ventilation (HFJV) -- High Frequency Oscillatory Ventilation (HFOV) -- Initial HFOV settings -- Other methods of ventilation: -- Machine volume -- Volume Guarantee -- Liquid ventilation -- Extracorporeal Membrane Oxygenation (ECMO): -- History -- Patient selection -- ECMO criteria -- Mechanisms of bypass -- Complications -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Mechanical Ventilation In Nontraditional Settings: -- Introduction -- Mechanical ventilation at home: -- Goals of Home Mechanical Ventilation (HMV) -- Indications and contraindications -- Patient selection -- Equipment selection -- Mechanical ventilation in mass casualty incidents: -- Causes of mass casualty -- Mass casualty and mechanical ventilation -- Triage systems for mass casualty incidents -- Strategic national stockpile -- Exclusion criteria for mechanical ventilation -- Personnel and planning -- Mechanical ventilation in hyperbaric condition: -- Rationale for Hyperbaric Oxygenation (HBO) -- Indications for HBO -- Endotracheal tube and ventilator -- Tidal volume fluctuations -- Monitoring and mechanical ventilation -- Defibrillation and cardiac pacing -- Mechanical ventilation in hypobaric condition: -- High-altitude cerebral and pulmonary edema -- Airplane cabin pressure -- Ventilator parameter changes under hypobaric conditions -- Pressure compensation -- Traveling with portable ventilators: -- Characteristics of portable ventilators -- Traveling in the United States -- Adjustment of tidal volume -- Portable oxygen concentrator -- Summary -- Self-assessment questions -- Answers to self-assessment questions -- References -- Additional resources -- Case Studies: -- Case 1: COPD -- Case 2: Status asthmaticus -- Case 3: Post-abdominal surgery -- Case 4: Head injury -- Case 5: Smoke inhalation -- Case 6: Drug overdose -- Case 7: Tension hemopneumothorax -- Case 8: Chest trauma -- Case 9: Acute respiratory distress syndrome -- Case 10: Myasthenia gravis -- Case 11: Guillain-Barre -- Case 12: Botulism -- Case 13: Meconium aspiration/patent ductus arteriosus -- Case 14: Persistent pulmonary hypertension of the newborn -- Case 15: Home care and disease management -- Case 16: End-of-life sedation on mechanical ventilation -- Appendix 1: Respiratory Care Calculations: -- A: Arterial oxygen tension to inspired oxygen concentration (PaO2/F1O2) index -- B: Cardiac Output (CO): Fick's estimated method -- C: Cerebral perfusion pressure -- D: Compliance: Dynamic (Cdyn) -- E: Compliance: Static (Cst) -- F: Corrected tidal volume (Vt) -- G: Deadspace to tidal volume Ratio (Vd/Vt) -- H: I:E Ratio -- I: Mean airway pressure (MPaw) -- J: Minute ventilation: expired and alveolar -- K: Oxygen content: arterial (CaO2) -- L: Oxygen index (OI) -- M: Shunt equation (Qsp/Qt): classic physiologic -- N: Shunt equation (Qsp/Qt): estimated -- O: Vascular resistance: pulmonary -- P: Vascular resistance: Systemic -- Q: Ventilator rate needed for a desired PaCO2 -- R: Weaning index: rapid shallow breathing -- Appendix 2: Normal Electrolyte Concentrations in Plasma -- Appendix 3: Oxygen transport normal ranges -- Appendix 4: Hemodynamic normal ranges -- Appendix 5: Glasgow coma score -- Appendix 6: Apache II severity of disease classification system -- Glossary -- Index

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