Chapter 75
- Respiratory Care
- Mark T. Grabovac
- Kevin Kim
- Thomas E. Quinn
- Raymond Hernandez
- Brian M. Daniel
The knowledge and skills required to deliver safe and effective
respiratory care were in large part developed by anesthesiologists. Facility with
many of these skills is essential for the practice of anesthesiology as well as for
the practice of critical care medicine. Respiratory care encompasses invasive and
noninvasive techniques (e.g., nasal continuous positive airway pressure [CPAP]) as
well as ambient-pressure (oxygen, aerosol, and bronchial hygiene therapy) and positive-pressure
therapies. The timely and appropriate use of ambient-pressure and noninvasive therapies
can often delay or prevent the need for invasive or positive-pressure therapy. As
our understanding of many disease states improves, the outpatient and perioperative
use of many aspects of respiratory care is increasing dramatically. Examples of
this include the routine nighttime use of noninvasive positive-pressure ventilation
(NIPPV) for the treatment of obstructive sleep apnea. Modes of positive-pressure
ventilation (PPV) have become increasingly complex as new technologies have emerged.
Understanding of traditional modes of mechanical ventilation as well as some familiarity
with newer modes is essential for the practice of anesthesiology.
Anesthesiologists are frequently called on to deliver cardiopulmonary
supportive techniques both inside and outside the operating room. An integral part
of these supportive techniques include modalities of respiratory care. The principles
of respiratory care that are commonly employed in the operating room, postanesthesia
care unit, intensive care unit (ICU), and emergency room are discussed in this chapter.
