新生儿机通气参数调节.ppt

* Loss of Tidal Volume due to gas compression in ventilator circuit VTDelivered = 10 mL = constant CTubing = 1.2 mL/mbar = constant VTLung [mL] CRS [mL/mbar] 四、机械通气的撤离 成功拔管的基本条件 1、FIO2 30% 时血气分析正常 2、吸气峰压 1.5 kg： 15 cm H2O 1.0 - 1.5 kg ： 12 cm H2O 1.0 kg： 10 cm H2O 3、IMV 频率 15/min 4、有平缓的自主呼吸 5、自主呼吸潮气量 5ml/kg 6、以上条件持续时间 24 h 成功拔管的特定条件 1、顺应性 1 ml/cmH2O 1.5 kg： 0.75 ml/cm H2O 1.5 kg： 0.5 ml/cm H2O 2、有明确的插管气漏 3、无额外的代谢负担（如，发热） 4、Hb正常 5、正常的胃肠功能和生长 拔管失败的原因 Open and effective PDA 开放 Phrenic nerve lesions 膈神经病变 Muscular disease 肌肉疾患 Airway anomalies 气道畸形 肺不张的治疗 1、气管清理及理疗 2、体位 3、提高平均气道压及延长吸气时间 4、高频通气 5、用肺表面活性物质液体灌洗 6、支气管镜抽吸 7、咳嗽动作 8、液体通气 * * * * * * 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. * * When the inspiration criteria are met, exhalation begins as pictured in yellow here. Normally, this curve resembles a football. * Overdistention is caused by a combination of PEEP and too much volume or pressure. A is the peak inspiratory pressure; B is the upper inflection point; C is the lower inflection point. The lower inflection point identifies the level of PEEP where the lung is more compliant. This is also referred to as critical opening pressure. The upper inflection point indicates where the lung becomes less compliant and illustrates where overdistension starts to occur. Decreasing the volume or pressure may help avoid barotrauma in this situation. * * * * * * 3 3 3 * 4 4 4 * 35 5 5 5 * * * * When the physical dimension of the tube is known. The pressure differnce between the two ends of the tube at a certain flow level can be calculated. Without Tube Compensation the patient has to generate this pressure additional to his normal muscular effort. If ATC is switched on, the ventilator measures the acutal flow every few milli seconds and generates the required pressure in the hose system to compensate for