机械通气常见(国外英语资料).doc

机械通气常见 Common mechanical ventilation Prevention and management of complications Air injury Reason - patient factors Ventilator factor - Operator factor Type - pneumothorax Subcutaneous emphysema - mediastinal emphysema Pneumothorax Type Tension pneumothorax - isotonic pneumothorax - low pressure pneumothorax Etiology or predisposing factors - ventilator mode or high or low pressure - has the patient received any treatment or rescue other than breathing machines that can induce pneumothorax? - does the patient have primary or predisposing factors that can cause pneumothorax? Pneumothorax - a patient aspect Congenital factor: congenital bullae of lung Acquired factors: - COPD - acquired bullae of lungs - chest trauma - rupture and rupture of lung tissue - severe cough or expectoration Medical factors of pneumothorax and non mechanical ventilation Cardiopulmonary resuscitation, cpr: External chest compression Intracardiac injection Various punctures: Deep venous puncture (internal jugular and subclavian V) - pleural puncture or biopsy Pneumothorax ventilator factors Excessive stress? Excessive tidal volume Improper use of PEEP and PSV Pneumothorax - clinical manifestation Chest pain: note that the patient is unable to complain Irritable and sweating? Hypoxia and cyanosis?: sudden hypoxemia ? circulatory failure: blood pressure down, heart rate increase Subcutaneous or mediastinal emphysema Pneumothorax sign: Chest X-ray: the most reliable basis for the diagnosis of pneumothorax Pneumothorax - emergency treatment Stop using ventilators Exhaust decompression - puncture exhaust - closed thoracic drainage - followed by a ventilator Pneumothorax - prevention Limiting ventilation pressure Be careful with PEEP and PSV When necessary, antitussive Careful chest trauma examination and treatment Subcutaneous or mediastinal emphysema Of gases entering the subcutaneous or mediastinum Gas source - lung tissue: mostly coexisting with pneumothorax - respiratory tract: inadvertently ca