The trajectory of care for patients with neurologic respiratory impairment can roughly be subdivided into the three stages of acute, post-acute and long-term care. Patients with acute neurological illness and respiratory impairment are treated in stroke units, intermediate care units or intensive care units, depending on the severity of their condition. Patients with respiratory impairment due to chronic or chronic progressive neurological conditions are treated in variable settings, comprising outpatient clinics, sleep medicine departments and hospital wards as well as medical and neurosciences intermediate and intensive care units. The disciplines of neurology and pulmonology both strongly contribute to the post-acute setting of neurorespiratory care. Post-acute treatment facilities, where neurological patients with tracheostomy or mechanical ventilation are treated, can be part of acute care hospitals or function as stand-alone institutions. Health care structures and centers for neurological patients with respiratory impairment have been comprehensively organized for only a few countries. To explore differences (and detect needs) this chapter provides some insights in healthcare structures and their variability between regions and countries – the disparity is obvious.

Neuromuscular disorders cause respiratory failure when they significantly impair the respiratory muscle pump. This is a complex system involving the diaphragm, intercostal, neck, shoulder girdle, abdominal wall and possibly paraspinal muscles. The dilator muscles of the palate, pharynx and larynx maintain a patent airway and air conduit. The diaphragm is the main muscle of inspiration, but is aided by the parasternal intercostals, and additionally by the accessory respiratory muscles in forceful inspiration, diaphragmatic weakness or compromised diaphragmatic function as is the case in lung emphysema. Exhalation is passive, but forceful expiration and cough require the abdominal wall and a portion of the intercostals. This chapter focuses on the physiology of the muscles involved in respiration, and the recognition of developing neuromuscular respiratory failure, its clinical evaluation and assessment, and basic principles of management.

Respiratory dysfunction can occur at one or more of the following levels: central neurons including the upper motor neuron, brainstem regions of respiratory control. lower motor neurons, peripheral motor nerves, the neuromuscular junction and the respiratory muscles. Any acute or chronic lesion or condition that affects regions of respiratory control can affect the respiratory system by altering breathing pattern and respiratory drive, leading to central breathing irregularities. Dysfunction of lower motor neurons, the peripheral motor nerves, the neuromuscular junction and the muscle typically results in an impairment of the lower motor neurons, the peripheral motor nerves, the neuromuscular junction or the muscle typically results in an impairment of the respiratory pump which commonly leads to chronic hypercapnia, also called respiratory failure type 2. Moreover, weakness of bulbar muscles can cause an airway obstruction resulting in apneic periods with hypercapnia and hypoxemia. Of note, central and peripheral alterations simultaneously affect ventilation in some disorders, which highlights the need for a specific and sometimes individual diagnostic approach. Considering the impact of respiratory insufficiency on morbidity and mortality, the respiratory function must be assessed and monitored regularly.

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.