肺保护机械通气课件.pptVIP

Clinical Observation Bob’s new protocol Performance of RM Set FIO2 at 1.0 Allow time for stabilization Insure appropriate sedation Insure hemodynamic stability Bob’s new protocol Performance of RM - PCV Pressure control ventilation: PEEP 20-30 cmH2O Peak Inspir Press 40-50 cmH2O Inspir Time: 1 to 3 sec Rate: 8 to 20/ min Time 1 to 3 min Set PEEP at 20, ventilate VC, VT 4 to 6 ml/kg PBW, increase rate, avoid auto-PEEP Measure dynamic compliance Decrease PEEP 2 cm H2O Bob’s new protocol Performance of RM - PCV Measure dynamic compliance Repeat until max compliance determined Optimal PEEP max comp PEEP+2 to 3 cm H2O Repeat recruitment maneuver and set PEEP at the identified settings, adjust ventilation After PEEP and ventilation set and stabilized, decrease FIO2 until PO2 in target range If response is poor, repeat RM, PEEP 25, Peak Pressure 45 If response is poor, repeat RM, PEEP 30, Peak Pressure 50 Bob’s new protocol Lung Recruitment Perform early in ARDS Ideal approach to RM most likely PC, limited patient data available using PC! Works better in extra pulmonary than primary ARDS? More difficult to recruit the lung the stiffer the chest wall! Start with low pressure, increase as tolerated and needed! If benefit lost after RM, PEEP inadequate! Bob’s new protocol Current conclusion PEEP = Pflex+2 ? PEEP = Pdeflex ? Vt = 6 ml/Kg √ Vt: Pplat 30 √ Vt: Pplat Puip Guidelines? Not available yet Marini JJ, Gattinoni L. Crit Care Med. 2004 Jan;32(1):250-5. Ventilatory management of acute respiratory distress syndrome: a consensus of two. CONCLUSIONS: Prevention of ventilator-induced lung injury while accomplishing the essential life-supporting roles of mechanical ventilation is a complex undertaking that requires application of principles founded on a broad experimental and clinical database and on the results of well-executed clinical trials. At the bedside, execution of an effective lung-protective ventilation strategy remains an empirical process best gu