波形分析在机械通气的应用PPT.ppt

PRESSURE-TIME CURVES Breath type delivered to the patient Work required to trigger the breath Breath timing (inspiration vs exhalation) Pressure waveform shape Adequacy of inspiration Adequacy of inspiratory plateau Adequacy of inspiratory flow Results and adequacy of a static mechanics maneuver Adequacy of the Rise Time setting Breath type delivered to the patient Breath type delivered to the patient CMV, with auto-flow on Measuring Static Mechanics illustrates a stable static pressure plateau measurement that differentiates the pressure caused by flow through the breathing circuit and the pressures required to inflate the lungs. The pressure-time curve can be used to verify the stability of the plateau when calculating static compliance and resistance. C 代表不稳定的气道平台压力，常见原因为漏气或者患者出现自主吸气 Assessing Rise Time 吸气斜率 Chiumello D, Pelosi P, Croci M, et al.,Eur. Respir. J., 2001. 18(1): p. 107-114. A the rise to pressure may be too slow. B ideal waveform 恰当的斜率设置 C A rise time that is too fast 流速不足 Adequate Flow Inadequate Flow Paw (cm H2O) Time (sec) Inadequate Flow 预置流速不足 The dished-out appearance of the airway pressure waveform illustrates the changes from the passive breath when flow does not meet patient demand. Progressive increases in patient effort during breaths 2 and 3 were created by manually lifting the test lung Triggering difficulty and unnecessary patient work 触发困难 第三次为患者触发的通气，虽然患者触发了呼吸机，但是P-T曲线呈下凹型，显示了预制流速不足 第一次呼吸患者未达到触发阈值，但是启动了按需阀，为时间触发； The sensitivity setting is –4 cm H2O. 第二次患者仍打开了按需阀，启动了自主呼吸，自主呼吸末，时间触发了一次同步间歇指令通气 吸气时的作功大小 吸气做功主要由吸气负压大小和持续时间长短决定，吸气负压越大和持续时间越长，吸气功越大，反之亦然 人机不同步 He was being mechanically ventilated and arterial blood gases were acceptable on ventilator settings of SIMV 12/min, VT 850 ml, PEEP 5 cmH2O and FiO2 0.40. He then became combative, requiring sedation and restraints. The end tidal CO2 had increased from 42 mmHg to 48 mmHg and arterial oxygen saturation had decreased from 98% to 94%. His heart rate increased from