PAV_新一代无创辅助通气模式.ppt

10/23/98 PAV Workshop * Infrequently a patient may experience respiratory distress on PAV in spite of adequate or even high levels of support. One possible cause is the presence of dynamic hyperinflation or Auto-PEEP. Indications that Auto-PEEP may be causing the respiratory distress are: 1) the patient appears to be having difficulty triggering a breath or there seems to be a delay in the trigger. 2) The flow waveform pattern will also help to identify the presence of airtrapping and Auto-PEEP. In this situation, EPAP may be titrated to counteract the triggering difficulty because of Auto-PEEP. Other medical interventions, bronchodilator administration may be appropriate to decrease airways resistance. 10/23/98 PAV Workshop * With Auto-PEEP, in order to initiate gas flow the patient must generate an effort greater than the Auto-PEEP. What happens if the effort is less than the Auto-PEEP? Nothing, a pressure differential is not created, therefore gas flow is not generated By adding EPAP to the airway, the pressures would be equal and triggering would be easier. This would reduce excess work done by the patient 10/23/98 PAV Workshop * The expiratory limb of flow is used to identify Auto-PEEP. If the expiratory limb of the flow pattern does not return to zero before the next breath, Auto-PEEP is present. 10/23/98 PAV Workshop * Continued respiratory distress may be related to a high respiratory drive due to agitation, metabolic acidosis or shock. Mild sedation may ease anxiety; the emphasis here though is on Mild. It may be necessary to switch to an alternate mode of ventilation which would permit heavy sedation. With metabolic acidosis and shock states heavy sedation may also be necessary until the underlying condition can be corrected with medical intervention. 10/23/98 PAV Workshop * In the event that the Max PAV limits -- pressure or volume -- are frequently activated, it may be necessary to evaluate the level of support. Most frequently th