机械通气（本科大课）.ppt

* 37 * 38 * * 27 17 Make sure to incorporate discussion on active exhalation valve in notes * 27 17 Make sure to incorporate discussion on active exhalation valve in notes * 31 * 32 12 * 33 * 36 * 39 设置最佳的吸气时间 500 cc 450 cc Lost VT 1 2 3 4 5 6 SEC 1 2 3 4 5 6 VT 600 cc 120 120 SEC . VLPM 0 呼吸环 Pressure-Volume 环 Flow-Volume 环 Pressure-Volume Loop (Type of Breath) Controlled Assisted Spontaneous Vol (ml) Paw (cm H2O) I: Inspiration E: Expiration I E E E I I Components of Pressure-Volume Loop Volume (mL) Inspiration Expiration PIP VT Paw (cm H2O) PEEP and P-V Loop Volume (mL) VT PIP Paw (cm H2O) PEEP Work of Breathing A: Resistive Work B: Elastic Work Pressure (cm H2O) Volume (ml) B A Inflection Points Pressure (cm H2O) Volume (mL) Lower Inflection Point Upper Inflection Points Inadequate Sensitivity Volume (mL) Paw (cm H2O) Increased WOB 气体泄漏和气体陷闭 Volume (ml) Pressure (cm H2O) Air Leak Inadequate Inspiratory Flow Paw (cm H2O) Volume (ml) Normal Abnormal Active Inspiration Inappropriate Flow Paw (cm H2O) Volume (ml) Higher PTA Increased Raw Higher PTA Lung Compliance Changes and the P-V Loop Volume (mL) PIP levels Preset VT Paw (cm H2O) COMPLIANCE Increased Normal Decreased Volume Targeted Ventilation Lung Compliance Changes and the P-V Loop Volume (mL) Preset PIP VT levels Paw (cm H2O) COMPLIANCE Increased Normal Decreased Pressure Targeted Ventilation 过度膨胀 Volume (ml) Pressure (cm H2O) With little or no change in VT Paw rises Normal Abnormal Flow-Volume Loop Volume (ml) PEFR FRC Inspiration Expiration Flow (L/min) PIFR VT 气体泄漏/陷闭 Inspiration Expiration Volume (ml) Flow (L/min) Air Leak in mL Normal Abnormal 气道阻力增加 Inspiration Expiration Volume (ml) Flow (L/min) Decreased PEFR Normal Abnormal “Scooped out” pattern 气道分泌物/冷凝水 Inspiration Expiration Volume (ml) Flow (L/min) Normal Abnormal In many patients, radiographic evidence of barotrauma (PIE, pneumomediastinum, etc) are often present before any clinical manifestations are evident and certai