机械通气总论精要.ppt

More commonly the chest is still moving. A detailed examination of the chest should be carried out looking in particular for endobronchial intubation, pneumothorax, collapse, pulmonary oedema and bronchospasm. In addition patient ventilator dysynchrony may result in desaturation. If a patient desaturates while on a mechanical ventilator it is important to consider both patient causes and equipment causes. Increase the inspired oxygen concentration to 100% and quickly check that the patient’s chest is still moving before going on to a more detailed examination. If the chest is not moving it may be a problem with the ventilator but this is unusual. In this situation the patient will be easy to ventilate manually. If the chest is not moving and the patient is not easy to ventilate then the problem is similar to a high airway pressure problem. More commonly the chest is still moving. A detailed examination of the chest should be carried out looking in particular for endobronchial intubation, pneumothorax, collapse, pulmonary oedema and bronchospasm. In addition patient ventilator dysynchrony may result in desaturation. A (PAW) B (PALV) Flow x resistance Volume/compliance+PEEP PAW = Flow x resistance + Palv ? when flow = 0 PAW = Palv 物理学: Equation of Motion 物理学: Equation of Motion 在吸气末暂停时测定气道压力 没有气流 估计肺泡最大压力 吸气末暂停压力 = 吸气平台压力 ? 肺泡压力 峰压与平台压差值: 大 ? 气道阻力高 小 ? 呼吸系统顺应性低 氧合下降 单侧插管 意外拔管/脱机 呼吸机故障 氧源故障 导致低氧性呼吸功能衰竭的所有原因 肺栓塞 气胸 氧合下降 胸廓运动? 调FiO2=1.0 氧合下降 胸廓运动? 调FiO2=1.0 人工通气 通气容易? 呼吸机故障 ETT/患者问题气道阻力升高 或顺应性降低 治疗病因? 调整呼吸机设置 Yes No 检查设置 与功能 No 氧合下降 胸廓运动? 调FiO2=1.0 体格检查 特别注意: 单侧插管气胸 肺不张 肺水肿 支气管痉挛 治疗病因? 调整呼吸机设置 Yes 氧合下降 胸廓运动? 调FiO2=1.0 人工通气 通气容易? 呼吸机故障 ETT/患者问题气道阻力升高 或顺应性降低 体格检查 特别注意: 单侧插管气胸 肺不张 肺水肿 支气管痉挛 治疗病因? 调整呼吸机设置 Yes No 检查设置 与功能 Yes No 机械通气 常用的机械通气模式 2 机械通气常见问题的处理 3 机械通气的应用 1 4 常见疾病的机械通气策略 机械通气患者的分类 呼吸力学及气体交换正常 严重气流阻塞 慢性呼吸功能衰竭急性加重 急性缺氧性呼吸功能衰竭 肺或胸廓限制性疾病 肺部正常患者机械通气的原因 中枢驱动力的缺乏 药物过量, 脑干结构损伤 神经肌肉疾病 高位颈髓损伤 急性特发性脊髓炎 重症肌无力 休克治疗中的辅助疗法 过度通气 颅脑损伤后ICP升高的治疗 呼吸机的最初设置 – 肺部正常 模式 FiO2 PEEP