AirwayPressureReleaseVentilation-RespiratoryTherapy：气道压力释放通气呼吸疗法.pptVIP

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AirwayPressureReleaseVentilation-RespiratoryTherapy：气道压力释放通气呼吸疗法.ppt

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AirwayPressureReleaseVentilation-RespiratoryTherapy：气道压力释放通气呼吸疗法

Disadvantages of APRV With increased Raw (e.g.COPD) the ability to eliminate CO2 may be more difficult Due to limited emptying of the lung and short release periods. If spontaneous efforts are not matched during the transition from Phigh to Plow and Plow to Phigh, may lead to increased work load and discomfort for the patient. Limited staff experience with this mode may make implementation of its use difficult. The End Lesson 1 Lab: Setup and manipulation of APRV on the Galileo ventilator and BiLevel on the PB 840. Use of clinical scenarios will be used to guide decision making. Lesson 1 assignment: Analyze current evidence based research on the use of APRV as a measure to decrease mortality in the ARDS patient. Write a minimum of 3 pages utilizing peer reviewed articles and APA referencing to support or refute APRV use as primary means to decrease mortality. * * Maintaining spontaneous ventilation tends to improve ventilation-perfusion matching by preferentially providing ventilation to dependent lung regions that receive the best blood flow. Setting PEEP or Plow in APRV Set PEEP at zero cm H2O. This provides a rapid drop in pressure, and a maximum DP for unimpeded expiratory gas flow. (Frawley, AACN Clin Issues 2001) Avoid lung collapse during Tlow. Establishing T PEEP (Time at low pressure) Set T PEEP (T low) so that expiratory flow from patient ends at about 50 to 75% of peak expiratory flow. This can be determine saving a screen and calculating peak expiratory flow. Or, it can be estimated Expiratory Flow T PEEP – Setting The Time Adults 0.5 to 0.8 seconds Pediatric/neonatal settings 0.2 to 0.6 seconds. Or one time constant. (TC = C x R) T PEEP – Using the Tc Release Time in ARDS Atelectasis can develop in seconds when Paw drops below a critical value in the injured lung. (Neumann P, JAP 1998, Newmann P, AJRCCM 1998, Frawley, 2001; McCunn, Internat’l Anesth Clinics 2002). Too long a release time would interfere with oxygenation and allow lung u