课件：无创正压通气在急性呼吸衰竭中的应用孙兵课件.ppt

* The maintenance of an SaO2 within the normal range (95–98%) is important in order to maximize oxygen delivery to the tissues and tissue oxygenation, thus helping to prevent end-organ dysfunction and multiple organ failure. * LV后负荷与LV跨壁压直接相关. T： Laplace公式：P = 2T/R 跨壁压为心腔内压与胸腔内压的差值. 引起肺泡压及胸腔内压升高的任何变化均可以降低左室后负荷. * EI RATE; * EI RATE; * Initial 90-120 minutes * ZXP,45yr,renal transplantation,PCP，first case of RICU * 那么，什么是呼吸机相关肺炎？事实上，把他叫人工气道相关肺炎更合适，因为从发生机制上讲，人工气道与VAP的关系非常密切，换句话讲，如果能拿掉人工气道，VAP就可以避免。 * CASE：康玉芳 * CASE：康玉芳 8-18全用NPPV * CASE：康玉芳 8-21-24使用IPPV * CASE：康玉芳 9.15病情稳定，转至综合科病房 9.29日出院 * CASE：康玉芳 9.15病情稳定，转至综合科病房 9.29日出院 * 10例病人，回顾性研究 Success rate (avoidance of intubation and no further assisted ventilation for 72 h) was achieved on six of nine occasions (66%) when NPPV was used as the initial mode of assisted ventilation. It failed after three episodes of planned (1) or self (2) extubation. Duration of successful NPPV was 64.5 h (23.5 to 80.5 h) with ICU discharge in the next 24 to 48 h for three of six patients. Unsuccessful episodes lasted 7.3 h (0.1 to 116 h) with need for conventional ventilation for an additional 5 days (2.7 to 14 days). Survival (ICU and hospital) for the 10 patients was 70%. * * * Tidal volume of 10 to 15 mg/kg can allow lungs to reach a total lung capacity of healthy lungs. In patients with Sepsis/ARDS, this can cause disruption of alveolar walls: ventilator-induced liquid lung and alveolar rupture (VILLAR) 22% REDUCTION in death * * Tidal volume of 10 to 15 mg/kg can allow lungs to reach a total lung capacity of healthy lungs. In patients with Sepsis/ARDS, this can cause disruption of alveolar walls: ventilator-induced liquid lung and alveolar rupture (VILLAR) 22% REDUCTION in death 第一部分 ALI/ARDS登记研究 ICU Patients 7095 ALI/ARDS 223 ALI 57 ARDS 166 Recruited and Randomized 40 Excluded 17 Excluded 133 Recruited and Randomized 33 惋姑斤哥勇中闰少荧憨拭气筒羔庙银芳巷角函帧卿淹专宁生尾衣杭僧梢花无创正压通气在急性呼吸衰竭中的应用孙兵ppt课件无创正压通气在急性呼吸衰竭中的应用孙兵ppt课件 研究场所与人员要求