HFOV (Dr VS Rajadurai)转载.ppt

UPDATE ON HIGH FREQUENCY OSCILLATORY  VENTILATION IN THE NICU 高频振荡通气新动态 新加坡竹脚妇幼医院新生儿科主任 萨米尔 拉惹杜莱医生 Dr VS Rajadurai Senior Consultant Head of NICU Dept of Neonatology KK Women’s and Children’s Hospital UPDATE ON HFOV纲要 HFOV: DEFINITION 高频振荡通气定义 HFOV : REASONS FOR DEVELOPMENT 高频振荡通气发展原由 1. To reduce ventilator associated lung injury by - preventing volutrauma 容量伤 - reducing oxygen exposure 减低氧气接触 - reduce incidence of CLD减低慢性肺病机率 2. To provide a method of assisted ventilation that allows severe pulmonary airleaks to heal探寻可治肺气漏的通气的方法 DIFFERENCES BETWEEN HFOV CONVENTIONAL VENTILATION 高频振荡通气与常规机械通气比较 CMV HFOV Rate (BPM) 呼吸频率 0-120 300-1200 Tidal Volume潮气量 (ml/kg) 4-20 0.1-5 Alv pressure 肺泡压力(cm/H20) 5-50 0.1-5 End-expiratory LV 呼气末压 low 低 high高 Expiration 呼气 passive被动 active主动 GAS EXCHANGE DURING HFOV高频振荡通气的气体交换 TYPES OF HFO VENTILATORS高频振荡通气呼吸机类型 Diaphragm HFOV 隔膜型 e.g.: Sensor Medics 3000A IE ratio 1:2 Most powerful Piston HFOV 活塞泵型 e.g.: Hummingbird Variable IE ratio 1:1 - 1:2 Hybrid devices: 混杂型 Spinning wheel or ventures to generate negative pressures during expiration IE ratio 1:1 e.g.: SLE HFO 5000，Drager Babylog 8000 HFOV DEVICES: EFFICACY高频通气器械效能 Mechanics, operation and run-time adjustment of the devices are quite different None of them are similar enough to be controlled in exactly the same manner 机械功能各异 NO human studies have directly compared different types of HFOV 仍未有比较用在人类各类高频通气机的研究报告 Currently, impossible to say if one type is better than the other 目前难说何类型为优 HFOV: ANIMAL STUDIES高频通气机的动物研究(1) HFOV: ANIMAL STUDIES高频通气机的动物研究 (2) HFOV: PRACTICAL MANAGEMENT高频通气机实践处理 HFOV: VENTILATORY STRATEGIES高频通气策略 HFOV: HIGH VOLUME STRATEGY高容量策略 (1) HFOV: HIGH VOLUME STRATEGY高容量策略 (2) HFOV: HIGH VOLUME STRATEGY 高容量策略 (3) HFOV: HIGH VOLUME STRATEGY 高容量策略 (4) HFOV: CONTROL OF VENTILATION控制通气－调整幅度 HFOV : VENTILATORY STRATEGIES 低容量策略 Low-Volum