呼吸力学与呼吸机波形及其临床意义精品.ppt

39 39 39 39 39 39 If your goal is to maintain a similar inspiratory time, this can be accomplished by increasing peak flow until you have approximate the same inspiratory time using the decelerating flow pattern as you did with the square flow pattern. This could decrease the potential to develop Auto-PEEP, as seen here. 41 41 41 41 41 41 33 33 Using both the Volume and Flow time curves can give you incite into setting the appropriate PIP in PCV. Say the physician orders PCV on his patient and tells you that he wants a VT of 500cc. You initially set up the PCV with a PIP of 20 cm, with a resulting VT of 450CC. Before you increase PIP to obtain additional VT, you may want to maximize inspiratory time. As you can see here at the blue arrow, inspiratory flow does not return to zero before cycling into expiration. What you lose above the curve you also lose below. 42 42 42 42 42 42 33 33 Pictured in blue here is potentially lost VT. Increasing inspiratory time to allow the flow to return to baseline may increase VT without increasing PIP. Since flow is controlled during volume ventilation, if the patient wants more than the set flow a condition of “flow starvation” occurs as pictured in the right three waveforms. The patient’s inspiratory flow demand increases from right to left. 43 43 43 43 43 43 What if your pressure curve in PCV starts looking like this. What do you suppose is happening here? 44 44 44 44 44 44 Inspiratory time may be set to long, the patient is attempting to expire while the ventilator is still delivering flow. If the inspiratory time was decreased to where the patient is starting to exhale, as shown by the optimal arrow here, the patient may be more comfortable with the ventilator. 45 45 45 45 45 45 How do you know the increased pressure is caused by the patient? Look at your flow curve. 46 46 46 46 46 46 If pressure is rising and flow is at zero, its the patient and not the ventilator that is increasing the pressure here. There c