导致无创通气失败常见原因.pptVIP

无创通气失败的常见原因和对策 东南大学中大医院呼吸科 林勇  内容 NIV的合并症 ■NIV失败的预测指标 高碳酸血症性呼吸衰竭 低氧血症性呼吸衰竭 IV失败的常见原因 NTV失败的相关因素 与环境/医疗团队相关 NIV禁忌症 患者相关因素 技术因素  State of the art Am I Respir Crit Care Med Vol 163. Pp 540-577, 2001 Noninvasive Ventilation SANGEETA MEHTA and NICHOLAS S. HilL FREQUENCY OF ADVERSE SIDE EFFECTS AND COMPLICATIONS OF NPPV WITH POSSI BLE REMEDIES Possible Remedy Mask-related Check fit, adjust strap, new mask type Facial skin erythem 20-34 cosen straps, apply artificial skin Claustrophobia Smaller mask, sedation 80-100鼓励闭口呼吸,尝试下颌带, 换为口鼻面罩,稍减低治疗压力 ust straps Gastric insufflation reduce Encourage mouth closure, try chin straps, oronasal mask asal mask. reduce pressures sligh Aspiration pneumon Careful patient selection Hypoten 5 Reduce inflation pressure Pneumothora  top ventilation if possible, reduce airway pressure if not Thoracostomy tube if indicated  在NV过程中,如何减少漏气? 选择合适型号和大小的面罩 选择的合适的固定系统 合适的面罩头带 合适的管路转接头 凝胶或泡沫密封 下颌带 Nava S et al. Respiratory Care 2009: 54: 71-82  State of the art Am I Respir Crit Care Med Vol 163. Pp 540-577, 2001 Noninvasive Ventilation 与压力或流量有关的因素 鼻充血 20-50类固醇鼻滴剂,减充血剂/抗组胺药 鼻窦/耳朵疼痛 10-30如不能耐受,降低压力 口鼻干燥 10-20鼻用生理盐水/润滑剂,湿化器 眼部刺激 10-20检査面罩,重新调整头带 胃部胀 5-10重新固定 胃肠消气泡药物( simethicone) 不耐受降压 Maior complications educe inflation pressure Pneumothorax 5 Stop ventilation if possible, reduce airway pressure if not horacostomy tube if indicated  State of the art Am I Respir Crit Care Med Vol 163. Pp 540-577, 2001 Noninvasive Ventilation 与面罩有关的因素 不适 30-50 调整面罩、头带,更换面罩类型 面部皮肤红肿20-34 松解头带,使用人工皮肤 幽闭恐惧 5-10 换用小面罩,使用镇静药 鼻梁溃疡 5-10 松解头带,人工皮肤, 更换面罩类型 痤疮样皮疹 5-10 局部类固醇或抗生素 Nasalyoral dryness Nasal saline/emollients, add humidifier, decrease leak Eye irritation 10-20 Check mask fit, readjust straps Gastric insufflation 5-10 Reassure, simethicone, reduce pressure if intolerable Air leak 80-100 Encourage mouth closure, try chin straps, oronasal mask g nasal mask, reduce lajar C