机械通气的模式概要.ppt

* 容量控制的A/C模式 与前不同支持在于吸气的流量波形。 * VC-SIMV+PSV 蓝色曲线代表指令通气，间断出现 两种不同的波形间断出现，可能代表两种不同模式 * PSV与PCV的区别：切换点的不同 * 如何理解常用机械通气模式的基本原理 * * Time cycled Assist control mode (called volume control by Maquet) “Reasonable” initial settings: tidal volume approx 8 ml/kg, RR 12, PEEP 5, I:E ratio 1:2 Inspiratory pause results in more even distribution of ventilation. Usual setting 5-10%. Always set FiO2 to 100% initially Skip over inspiratory rise time * * High PO2 – turn down FiO2 Respiratory acidosis – need to increase alveolar ventilation. Choices are to increase respiratory rate or increase tidal volume or both * Increasing tidal volume increases alveolar pressure and risk of barotrauma while risk of * Pplat already quite high – aim for 30 and risk of gas trapping in a patient who does not have obstructive airways disease and has a resp rate of 12 is low * Decrease FiO2 and increase respiratory rate * * Need to set pressure support, PEEP, FiO2 and trigger sensitivity Lung compliance has improved and plateau pressure has now fallen to 20. As a result a pressure support of 15 above PEEP of 5 should generate similar tidal volumes. Oxygenation has also improved so the FiO2 can be further reduced. PEEP is relatively low and can be left at 5. The other important setting to review is the trigger sensitivity which is currently set on flow * * * 压力上升时间（rise time） 反应压力上升的快慢 在不同呼吸机中的设置方法和意义存在差异 设置时间：Galieo、Drager 设置百分比：simens、PB840 调节主要吸气初期改善人机的协调性 评估 吸气初期人机协调性 * rise time的调节 * 吸呼比的调节 调节吸呼比主要调节吸气时间 吸呼比不能控制自主的呼气时间 * 呼气末正压（PEEP） 初始设置 常规设置于 3~5cmH2O COPD患者：PEEPi的70%~80%，一般5~8 cmH 2O ARDS患者：8~12 cmH 2O 评估 血氧饱和度 血气指标 对循环的影响 压力（容控时）和潮气量（压控时）的监测 * 吸入氧浓度（FiO2） 初始设置100% 维持患者基本的氧合：PaO260cmH2O,SpO292% 尽量将FiO2降至50%以下 * 病例 60岁女性患者 部分肝切除术后 无基础的肺和心脏疾病 仍处于肌松状态 * Mode 通气模式的选择 Assist control Pressure control SIMV (Pressure support) * * Startbreath O2breaths Exp.hold Insp.hold Mainscreen Menu Quickstart Alarmprofile Save Trends i ! 12-25 15:32 ? Charles Gomersall 2003 ModeVolume Control Automode Admit