(精编)【医学精品课件】Monitoring The Critically Ill Children教学课件.pptVIP

Monitoring The Critically Ill Children ;;Principles and Philosophy in Critical Care Medicine;The goals of monitoring the critically ills (I);;Characteristics of monitoring children;Patient (2yo) in Car Accident;Patient (2yo) in Car Accident;;Perfusion;Lactic acidosis and outcome of ECMO;Gastric intramural pH (Tonometry);Gastric tonometry and septic shock ;心輸出量的評估;Hemodynamic Monitoring;Fick Method;非侵入性監測NICO;Hemodynamic monitoring;如何測量Hemodynamics?;;Thermodilution and Cardiac Output;;非侵入性監測：PiCCO;PiCCO: G?dje et al. Crit Care Med 2002 Vol. 30, No. 1;;非侵入性監測：Hemosonics;非侵入性監測：Hemosonics;非侵入性監測：Impedance Cardiography;;;Principle;Disadvantages of invasive cardiovascular monitoring;;;非侵入性心輸出量之評估方法;;Tips for cardiovascular monitoring;tPAOP = eePAOP ? [PEEPtot ? (?PAOP/ ? Palv)];CVP, PAOP and preload;Response to fluid challenge;Respiratory variations in CVP predict response to fluid challenge;Respiratory Changes in Arterial Pulse Pressure and Fluid Responsiveness;;Respiratory monitoring;Respiratory monitoring;How to interpret and use ABG;Yildizdas et al. Arch Dis Child, 2004; 89:176-180;Pulse Oximetry;;The limit of pulse oximetry;End-tidal CO2;Area p=q;X=alveolar ventilation, Y=alveolar dead space, Z=airway dead space, ;Vd/Vt: Clinical for Extubation Hubble , CCM , 2000. ;; Results: Individual Outcomes;Transcutaneous pO2;The limit of transcutaneous blood gas;Mechanical graphics;Mechanical graphics;Tidal Volume Determination;Results: Infant Circuit;; Vt(ml) p Exp valve Vt 185.4 ± 96.6 Calcuated Vt 167.8± 94.6 0.16 Pneumotach Vt 135.3± 75.8 0.03;;;腦監測 ;腦監測;腦功能之監測;;Bispectral Index Hsia et al. Ped Neurol 2004; 31: 20-23 ;腦血流量監測;腦血流量監測;Impaired Pressure-Flow Autoregulation;經顱骨超音波都卜勒監測-TCD;經顱骨超音波都卜勒監測-TCD;經顱骨超音波都卜勒監測-TCD;遠紅外線監測-NIRS;遠紅外線監測-NIRS;腦代謝率CMRO2之監測;腦代謝率CMRO2之監測;侵入性的DO2評估;;SjvO2 monitoring in PICU;Episodes of Increased OER (I);Clinical Condition Correlated