老外的机械通气的幻灯.pptVIP

MECHANICAL VENTILATION Things “I” wish I knew when I was an Intern Amit Gupta, MD Internal Medicine North Mississippi Medical Center Mechanical Ventilation Indications for Intubation and Ventilation Principles of Mechanical Ventilation Patterns of Assisted Ventilation Ventilator Dependence: Complications Liberation from Mechanical Ventilation: Weaning Troubleshooting Arterial Blood Gases Indications for Mechanical Ventilation “….An opening must be attempted in the trunk of the trachea, into which a tube or cane should be put; You will then blow into this so that lung may rise again….And the heart becomes strong….” -Andreas Vesalius (1555) Indications for Mechanical Ventilation 1. “Thinking” of Intubation: elective v/s emergent 2. “Act of weakness?” 3. Endotracheal tubes are not a disease and ventilators are not an addiction 4. And the usual elective and emergent indications that you all know! Objectives of Mechanical Ventilation Improve pulmonary gas exchange Reverse hypoxemia and Relieve acute respiratory acidosis Relieve respiratory Distress Decrease oxygen cost of breathing and reverse respiratory muscle fatigue Alter pressure-volume relations Prevent and reverse atelectasis Improve Compliance Prevent further injury Permit lung and airway healing Avoid complications Strategies for Mechanical Ventilation Monitoring Lung Mechanics Proximal Airway Pressures (end-inspiratory) 1. Peak Pressure Pk Function of: Inflation volume, recoil force of lungs and chest wall, airway resistance 2. Plateau Pressure Pl Occlude expiratory tubing at end-inspiration Function of elastance alone Use of Airway Pressures Pk increased Pl unchanged: Tracheal tube obstruction Airway obstruction from secretions Acute bronchospasm Rx: Suctioning and Bronchodilators Use of Airway Pressures Pk and Pl are both increased: Pneumothorax Lobar atelectasis Acute pulmonary edema Worsening pneumonia ARDS COPD wit