机械通气1【美】.pptVIP

Mechanical Ventilation in Chronic Obstructive Pulmonary Disease Tim Op’t Holt, Ed.D., R.R.T. Professor Cardiorespiratory Care University of South Alabama Mobile, Alabama Discussion Points Determining the need for ventilation Noninvasive versus invasive ventilation Instituting noninvasive ventilation Instituting invasive ventilation Managing ventilation Drug delivery during mechanical ventilation Managing auto-PEEP Weaning the patient Determining the Need for Ventilation Hypercapnic respiratory failure Pathophysiologic deterioration Acute Hypercapnic Respiratory Failure PaCO2 50 mm Hg with a pH 7.3, low PaO2 normal P(A-a)O2 CNS depression, neuromuscular disease hypopnea, somnolence, coma hypoxemia caused by hypoventilation and/or low V/Q Example pH 7.20 PaCO2 63 mmHg PaO2 48 mmHg HCO3- 24 mEq/L SaO2 72% Chronic Hypercapnic Respiratory Failure PaCO2 50 mm Hg Near normal pH, due to renal compensation Common in COPD Not an independent indication for ventilation Example pH 7.38 PaCO2 70 mm Hg PaO2 62 mm Hg HCO3- 41 mEq/L SaO2 90% Acute on Chronic Respiratory Failure PaCO2 50 mm Hg pH 7.3, insufficient renal compensation Severe hypoxemia Exacerbation of COPD, often with pneumonia Ventilation indicated Example pH 7.25 PaCO2 82 mmHg PaO2 35 mmHg HCO3- 35 mEq/L SaO2 40% Pathophysiologic Deterioration Noninvasive versus Invasive Ventilation Consider Noninvasive Ventilation Acute exacerbation of COPD Respiratory acidosis (pH 7.25-7.35) despite optimal oxygen and medical therapy Able to protect airway Conscious and cooperative Hemodynamically stable NIV may be a ceiling for therapy if intubation is not an option Secretions may limit the effectiveness of NIPPV in bronchiectasis Noninvasive versus Invasive Ventilation Consider Invasive Ventilation The airway cannot be protected (patient is semi or unconscious) Life-threatening hypoxemia Severe comorbidity (heart failure) Confusion/agitation Copious respiratory secretions Focal consolidation on chest radiograph Sev