Mechanical Ventilation培训讲义.pptVIP

MECHANICAL VENTILATION KENNEY WEINMEISTER M.D. INDICATIONS FOR MV Hypoxemia Acute respiratory acidosis Reverse ventilatory muscle fatigue Permit sedation and/or neuromuscular blockade Decrease systemic or myocardial oxygen consumption INDICATIONS CONTINUED Reduce intracranial pressure through controlled hyperventilation Stabilize the chest wall Protect airway Neurologic impairment airway obstruction TYPES OF CONVENTIONAL MV Timed cycled Home ventilators Pressure cycled Pressure controlled Volume cycled Flow cycled Pressure support VOLUME VENTILATION Controlled mechanical ventilation CMV Assist-control AC Synchronized intermittent mandatory ventilation SIMV Which mode? VENTILATOR SETTINGS Tidal volume 10 to 15 mL/kg Respiratory rate 10 to 20 breaths/minute normal minute ventilation 4 to 6 L/min Fraction of inspired oxygen Flow rate and I:E ratio PRESSURE SUPPORT VENTILATION Flow cycled preset pressure sustained until inspiratory flow tapers to 25% of maximal value Comfortable Used mainly as a weaning mode Wean pressure until equivalent to air way resistance peak - plateau pressure PRESSURE CONTROLED VENTILATION Pressure cycled Volume varies with lung mechanics Minute ventilation is not assured Improves oxygenation recruitment of alveoli Lessens volutrauma? SETTINGS FOR PRESSURE CONTROL VENTILATION Inspiratory pressure I:E ratio 1:2, 1:1, 2:1, 3:1 Rate FIO2 Peep PRESSURE REGULATED VOLUME CONTROLLED Ventilate with pressure control Preset volume Inspiratory pressure is adjusted breath to breath Minute ventilation is maintained INDICATIONS FOR PEEP ARDS Stabilize chest wall Physiologic peep Decrease Auto-peep? CONTRAINDICATIONS FOR PEEP Increased intracranial pressure Unilateral pneumonia Bronchoplueral fistulae PEEP Increases FRC Recruits alveoli Improves oxygenation Best Peep based on lower inflection of pressure volume curve TROUBLE SHOOTING VOLUME VENTILATION High pressure alarm Breath sounds CXR Low tidal volume disconnected Desaturation TROUBLE SHOOTING PRESSURE V