机械通气总论课件.pptVIP

慢性呼吸功能衰竭急性加重 插管时低灌注常见 心动过速 低血压 暂时中断机械通气并进行扩容 慢性呼吸功能衰竭急性加重 机械通气的目的 使患者和呼吸肌肉得到36 – 72小时的充分休息 适当的低通气 呼吸参数的最初设置 - ACRF 模式 FiO2 PEEP (cmH2O) Vt (ml/kg) RR (min-1) 流量(lpm) 叹息 正常 A/C 0.5 5 8-12 10 60 Y 哮喘 A/C 0.5 0 5-7 10-18 60 N ACRF A/C 0.5 5 5-7 24 60 Y AHRF A/C 1.0 15 5-7 24 60 N 限制性 A/C 0.5 5 5-7 20 60 Y 急性缺氧性呼吸功能衰竭 机械通气的目的 减少分流 避免氧中毒 选择不加重肺损伤的机械通气模式 急性缺氧性呼吸功能衰竭 PEEP的调整 最小PEEP法 FiO2 ? 0.6时保持SaO2 90%的最小PEEP 肺开放 静态P-V曲线的低位转折点以上2 cmH2O 肺或胸廓限制性疾病 肺部疾患 晚期肺纤维化 晚期ARDS 腹部疾患 大量腹水 其他胸廓异常 脊柱后凸畸形 肺或胸廓限制性疾病 减少死腔通气的方法 降低分钟通气量 纠正低血容量 * * * * * * * * * * * The cause of the high airway pressure may also be obstruction in the ventilatory circuit. This is most commonly due to water pooling in the circuit or to a filter that is filled with water. Note that the obstruction is often in the expiratory limb of the circuit which results increased PEEP and hence airway pressure[paw12] * * * * * * * * 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. * 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 h