This chapter covers respiratory physiology, including lung volumes and mechanics, ventilation and perfusion, compliance, diffusion, oxygen transport, carbon dioxide transport, effects of hypercarbia and hypoxemia, arterial blood gas interpretation, work of breathing, control of ventilation, non-respiratory functions of the lung, and the effects of perioperative smoking. The material is presented in a concise review format, with an emphasis on key words and concepts.

This chapter provides an outline of the areas of paediatric intensive care relevant to an anaesthetist. The chapter examines current epidemiology in critical care and the characteristics of children requiring transfer from local hospitals to specialist centres. It reviews differences between adult and paediatric respiratory physiology, outlines an approach to medications used in intubation and discusses respiratory support for critically unwell children. The chapter provides key basic guidance on the use of high-frequency oscillatory ventilation (HFOV) in children. Maintenance fluid and inotrope selection are also reviewed. The chapter also reviews presentations commonly encountered on paediatric intensive care units (PICU) across respiratory, cardiovascular, gastrointestinal, renal, neurological, metabolic and infectious conditions. Neuroprotection criteria are provided, with key relevance to anaesthetists who may need to undertake time-critical transfers from their usual place of work to neurosurgical centres. Organ donation and non-accidental injury are also discussed.

This chapter details the epidemiology, route of spread, symptoms and prevalence, relating to viral infections acquired while abroad (HBV, HAV, HEV, HIV, noroviruses, dengue fever, arboviruses, haemorrhagic fever viruses, rabies).

This chapter provides an overview of the antiviral drugs currently available, including maraviroc, aciclovir, penciclovir, ganciclovir, amantadine, zydovudine, adefovir, ribavirin, indinavir , oseltamivir, zanamivir, interferon alpha, rituximab , palivizumab, cidofovir, brincidofovir, foscarnet, remdesivir and paxlovid with an indication of their modes of action for treating virus infections, including HIV, herpes viruses, respiratory viruses, HBV, HCV, CMV, adenoviruses , BK, EBV (especially for PTLD), RSV, poxviruses and SARS-CoV-2.

This chapter deals with how infection control procedures can be used to minimise the spread of viral infections transmitted via the respiratory, gastrointestinal, blood-borne, sexual, vertical and vector-borne routes. It also details infection control strategies in hospitals and in the community via universal precautions, respiratory precautions, enteric precautions and those for highly dangerous pathogens. Post-exposure prophylaxis and management of outbreaks is also discussed along with a list of notifiable infections.

This chapter details the epidemiology, route of spread, prevalence and incubation periods of viruses causing respiratory symptoms (adenoviruses, SARS-CoV-2, enteroviruses, influenza, HMPV, parainfluenzaviruses, RSV, rhinoviruses). It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

Overview of respiratory complications such as hemoptysis, hiccups, laryngectomy and tracheostomy troubleshooting, airway obstruction, pneumonitis, and pleural effusion management

Overview of respiratory complications such as hemoptysis, hiccups, laryngectomy and tracheostomy troubleshooting, airway obstruction, pneumonitis, and pleural effusion management

Overview of respiratory complications such as hemoptysis, hiccups, laryngectomy and tracheostomy troubleshooting, airway obstruction, pneumonitis, and pleural effusion management

Overview of respiratory complications such as hemoptysis, hiccups, laryngectomy and tracheostomy troubleshooting, airway obstruction, pneumonitis, and pleural effusion management

Overview of respiratory complications such as hemoptysis, hiccups, laryngectomy and tracheostomy troubleshooting, airway obstruction, pneumonitis, and pleural effusion management

Overview of respiratory complications such as hemoptysis, hiccups, laryngectomy and tracheostomy troubleshooting, airway obstruction, pneumonitis, and pleural effusion management

Overview of respiratory complications such as hemoptysis, hiccups, laryngectomy and tracheostomy troubleshooting, airway obstruction, pneumonitis, and pleural effusion management

Overview of respiratory complications such as hemoptysis, hiccups, laryngectomy and tracheostomy troubleshooting, airway obstruction, pneumonitis, and pleural effusion management

Anaesthetic breathing systems are used to deliver oxygen and anaesthetic gases to patients and remove carbon dioxide. A breathing system is most commonly attached to an anaesthetic machine, which is designed to deliver the fresh gas flow to the patient via a facemask, a supraglottic device or an endotracheal tube. The breathing system used can affect the composition of the gas and volatile anaesthetic mixture inhaled by the patient, and so it is important to understand the different breathing systems used in anaesthesia. This chapter describes the key components of the different breathing systems and explores the benefits and disadvantages of the circuits in the Mapleson classification.

Key Learning Points

1. 1. Fibreoptic bronchoscopy (FOB) is generally a safe procedure that is performed at the bedside in the ICU, thus avoiding potentially dangerous transfers out of the ICU.

2. 2. FOB is utilised for both diagnostic and therapeutic purposes.

3. 3. FOB-guided broncho-alveolar lavage (BAL) and protected brush specimen (PSB) are extremely valuable procedures and have a high diagnostic yield in identification of the causative organism in pneumonia.

4. 4. FOB is increasingly used in managing difficult airway and in inserting percutaneous tracheostomy devices.

5. 5. In intubated patients, FOB increases airway resistance during the procedure. This causes an increase in the peak inspiratory pressure (PIP) and peak end-expiratory pressure (PEEP), which may result in barotrauma.