呼吸机专业培训讲义.ppt

ICU: Intensive Care Unit, LOS: Length of Stay, VAP: ventilator Associated Pneumonia Certain Alarm limits can be deactivated :- lower MV- upper Vti- Apnoea alarm: 5s to 60s and OFF - TDisconnect: “airway pressure low” alarm delay can be set between 0-60s If CPAP/ASB is used while in non invasive ventilation the new parameter Tinsp limits the ASB-stroke (PSV-stroke). Use of all ventilation modes Mask ventilation can complement the process of weaning for intubated patients by reducing the re-intubation rate. In other cases it might prevent intubation in the first place. Changing from conventional to mask ventilation is often associated with a change of devices. Literature: [1] J. Briegel, E. Kilger, B. Pichler, Nichtinvasive Beatmung in: R. Kuhlen, J. Guttmann,R. Rossaint, (2000) Neue Formen der assistierten Spontanatmung. UrbanFischer Verlag München/Jena ISBN 3-437-22320-8[2] Kuhlen R, Rossaint R, (1999) Noninvasive positive pressure ventilation for weaning from invasive mechanical ventilation. Intensive Care Med 25:1355-1356 Peak and Mean airway pressures are reduced Less invasive, less mechanical Weaning is smooth and effortless Less sedation and muscle relaxants Spontaneous breathing contributes to better gas exchange and secretion clearance. Greater comfort and less stress for patients Peak and Mean airway pressures are reduced Less invasive, less mechanical Weaning is smooth and effortless Less sedation and muscle relaxants Spontaneous breathing contributes to better gas exchange and secretion clearance. Greater comfort and less stress for patients APRV是我们独一无二的模式，反比程度？ 5 辅助呼吸(AMV)的P-V环 自主呼吸负压触发(纵轴左侧为负压), 然后呼吸机给予一次正压通气达到目标后(压力或潮气量), 即转换为呼气回复至0. 纵轴左侧的吸气启动这部分面积相当触发吸气所作之功, 左小三角区及上升肢上内区为吸气相, 吸气相面积代表克服气道阻力之功, 图中大三角形区为呼气相, 呼气相面积代表克服顺应性所作之功. 顺应性改变的P-V环 上升肢向横轴或纵轴倾斜说明顺应性的变化, 图中实线的P-V环向横轴倾斜说明顺应性降低(呼吸机设置不变), 在VCV中增加了平坦部分, 虚线部分向纵轴偏斜说明顺应性增加, 因为容积未变但压力有所减少. 阻力改变时的P-V 流速恒定的通气在设置不变情况下, 若阻力改变, P-V环右侧肢(即上升肢)徒直度不变, 而吸气肢呈水平移位,向右移位即阻力增加, 向左移位即阻力降低. P-V环反映肺过复膨张部分 流速