机械通气南京分析报告.ppt

PUMCH * 机械通气常用通气模式选择 A/C 或 PC SIMV+PSV PSV 机械通气遵循的基本原则 呼吸机设置与病情相结合原则 保证全身氧输送原则 机械通气肺保护原则 动态监测原则 PUMCH * 勤学习 勤练习 勤观察 勤动脑 要想掌握机械通气技术——勤学苦练 PUMCH * * * * 36 36 36 36 36 Simply put, the lower the ESENS, the longer the time before inspiration ends. The higher the ESENS setting, the shorter the inspiratory time. In general, the most appropriate ESENS setting is compatible with the patient’s condition, neither extending nor shortening the patient’s intrinsic inspiratory phase. ESENS can be adjusted by patient assessment. If inspiratory times appear to exceed the inspiratory efforts of the patient, a higher ESENS can be attempted to see if patient comfort improves. If the breath appears to be terminating prematurely, a lower ESENS can be set and patient comfort re-evaluated as well as it’s effect on tidal volume. * 34 34 34 34 34 18 Most ventilators currently on the market today terminate the inspiratory phase in Pressure Support Ventilation (PS) according to set termination criteria. This criteria is usually a percent of the peak flow for that particular breath. Clinicians have been limited in the past due to the inability to adjust this termination criteria. Expiratory Sensitivity (ESENS) defines the percentage of the projected peak inspiratory flow (VMAX) at which the ventilator terminates flow and thus cycles from inspiration to expiration during spontaneous breathing. A fixed PS termination criterion may potentially result in several clinical issues. If inspiratory flow terminates too early, it can lead to a decreased tidal volume, or increased inspiratory muscle load if the patients inspiratory effort persists after the ventilator has cycled flow off. Conversely, if inspiratory flow persists beyond patient effort which may happen when leaks are present, it can result in unnecessary expiratory work and patient/ventilator dysynchrony. 压力控制通气 – 吸气的开始 1 t 吸气相根据预置的呼吸频率或当患者触发时开始 压力控制通气 – 吸气的进行 2 3 I 压力控制模式保证在整个吸气相持续保持预置的吸气相压力. 呼