(精选)ARDS 英文课件教学课件.pptVIP

gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk-07 * gkk * INVERSE RATIO VENTILATION(IRV) I:E 1 PC-IRV / VC-IRV Ti with set pr opening of stiff alveoli units improved oxygenation Te not allowing alveoli to collapse development of intrinsic PEEP reduction of shunting gkk * IRV……, Improve oxygenation by Reducing intra pulmonary shunting Improvement of V/Q matching Decreased dead space ventilation Increased MAP intrinsic PEEP Useful when high FiO2 high PEEP to be avoided gkk *  Inverse ratio ventilation Inverse ratio ventilation is reserved for severe cases when it is impossible to oxygenate the patient adequately. Treatment involves increasing the amount of time that the ventilator is inspiring versus expiring. Patients normally spend more time exhaling than inhaling, at a ratio of about 3:1. Increasing the amount of time spent inhaling re-expands more collapsed alveoli than positive pressure alone. This is an uncomfortable technique and usually requires sedation and a muscle-paralyzing drug that keeps the respiratory muscles from resisting the unnatural inverse ratio ventilation. gkk * Distribution of lung infiltrates in acute respiratory distress syndrome is non-uniform. Repositioning into the prone position (face down) might improve oxygenation by relieving atelectasis and improving perfusion. Prone position ventilation gkk * Improved V/P in previously atelectactic areas due to uniform distribution of plural pr -Lamm etall Requires atleast more than 6 hrs/ day of prone ventilation. A significant decrease in right ventricular enlargement and a significant reduction in septal dyskinesia, after 18 h of prone positioning.-Vielliard etall ,CHEST-OCT-2007 No improvement in mortality in clinical trials Prone position ventilation gkk * Fluid management Several studies hav