ICU通气治疗的作用(英文).pptVIP

12/10/NAPCON 2000 DR.T.M.K. 12/10/200 NAPCON 2000 DR.T.M.K ROLE OF CPAP IN ICU DR.T.MOHAN KUMAR, MD,AB,DPPR,FCCP, CHIEF SENIOR CONSULTANT PULMONOLOGIST, DEPARTMENT OF PULMONOLOGY CRITICAL CARE, SRI RAMAKRISHNA HOSPITAL, COIMBATORE TAMIL NADU Respiratory failure Low arterial oxygen tension Lung failure Pump failure Respiratory muscle dysfunction Pulmonary hyperinflation Intrinsic PEEP MECHANICAL VENTILATION ARF most frequent cause If conservative treatment fails,MV through an ET or Tracheostomy tube Classical indications are : deterioration of consciousness,cardiac or respiratory arrest, impending respiratory muscle fatigue. MECHANICAL VENTILATION The goals are : 1.to support blood gases 2.to unload respiratory muscles. This gives time for the ARF to subside. Complications due to intubation,through out the course of MV ,after removing the tube or tracheostomy. The recent methods of noninvasive ventilation is mainly to reduce complications ensuring the same level of efficacy. CLINICAL USE OF CPAP AIRWAY DISEASE CPAP CPAP improved efficacy of ventilation by preventing bronchiolar collapse during expiration thus reducing work of breathing in COPD [Ann Allergy 1973;31:72-78] Sensation of dyspnoea reduced ,well tolerated reduced PCO2[Chest 1993;104:1694-1697] 15 minutes of CPAP through nasal mask with 10 cm H2o in COPD improvement in Pao2 reduction in PCO2 in acute exacerbations[AmJRespir Crit CareMed1994 ;149:1069-1076 In patients with hypercapnia and respiratory insufficiency good results[Chest,1993;103:143-150] Individual values of gas exchange variables in patients with chronic airflow obstruction during mechanical ventilation CPAP IN ASTHMA Use of mask CPAP produces a back distending pressure which keeps open the bronchial and bronchiolar structures that physiologically constrict durng the expiratory cycle, inducing more emptying of the alveoli [ Lancet 1936;231:981-983 , Chest 1991100:1024-1027, Eur Respir J 1990;3:625-632] Relationship of elast