课件：呼吸机波形及其临床意义.ppt

34 34 34 34 34 34 What do you thing might be happening here? 35 35 35 35 35 35 Well, what’s happening here is that patient is missing efforts due to Auto PEEP. When Auto PEEP is present, the patient has to pull negative through the Auto PEEP to the pressure or flow sensitivity setting. Let’s arbitrarily say that the patient has 7 cm H2O of Auto PEEP and the pressure sensitivity is set at 2 LPM. The patient therefore has to pull a negative 9 cm H2O in order to trigger the ventilator. In flow triggering, flow is not initiated until the patient has created a negative pressure in the lungs, and then pulls enough flow to met the flow trigger sensitivity. Either way undetected Auto-PEEP can cause increased work of breathing for the patient. 37 37 37 37 37 37 Observing the Pressure Time curve will the clinician in determining if a equilibrium has been achieved between the patients lungs and the circuit. This is demonstrated by a stable pressure as pictured here at the arrow, and is facilitated by setting an adequate expiratory pause time to allow enough time to achieve this equilibrium and thus a stable pressure. 38 38 38 38 38 38 As we discussed earlier, both square and decelerating flow patterns are commonly used in clinical practice. We will not debate the clinical application of these flow patterns, but will take time to point out the impact of changing from a square to decelerating flow curve in volume ventilation without changing the set peak flow. Depicted here we see a change from square to decelerating at the same peak flow setting. Note the increase in inspiratory time with the decelerating flow pattern. 39 39 39 39 39 39 If your goal is to maintain a similar inspiratory time, this can be accomplished by increasing peak flow until you have approximate the same inspiratory time using the decelerating flow pattern as you did with the square flow pattern. This could decrease the potential to develop Auto-PEEP, as seen here. 41 41 41 41 41 41 33 33 Usi