医学交流课件：开放通气.pptVIP

压力控制不及时,不精确, 在DuoPAP中竟然出现峰压 自主呼吸时流量不能及时跟上, 导致压力剧烈下降; 触发有点困难噢; CPAP时有人机对抗? DuoPAP中有人机对抗? 无法开放通气. Galileo- DuoPAP模式 1 5 2 4 3 严重的人机对抗; Galileo- APV(相当于PRVC) 1 Galileo - APRV模式 自主呼吸存在时压力控制相当迟滞, 导致压力剧烈变动; CPAP时人机对抗; APRV时人机对抗. 1 2 3 总结 与Drager 呼吸机比较, 它们的通气表现只能说一般, 包括触发和控制的稳定性; 所有的模仿模式, APRV, BiPhasic, DuoPAP等的开放通气性能相当差, 可以与Savina和Evita的图形作一比较, 区别就一目了然了. 所以, 起个好听的名字不难, 关键是做得怎么样! Thank you foryour attention.And need your input * * * The standard Mandatory Ventilation modes used in every ICU are IPPV and PCV (very seldom). Both Ventilation Modes guarantee the Patients Ventilation: IPPV, guarantees a Minute Volume, PCV guarantees that the pressure will never pass a previously set Pmax level. But both modes interact poorly with the patient, as you can see in the drawings. The Ventilator will start fighting the patient, because the vent is only able to do what it was instructed to do, give mandatory strokes one after the other regardless of the patients efforts. Other events like coughing will also interrupt ventilation, creating high airway pressures. The consequences are well known: alarms and sedation of the patient. So the patient wont suffer anymore from an inconsiderate ventilator that does not allow him to breath spontaneneously (by the way the patient will be very quiet and unable to do anything). The patients spontaneous breathing is surpressed... (The blue part of our lung drawing is inactive, there is no creation of negative pressures by expansion of the diaphragm of the lung, only the red part the positive pressure generated by the mandatory strokes is still there) * When he a patient is under Controlled Mechanical Ventilation, sometimes she will begin to make some small inspiratory efforts. Traditionally, this presents a problem. The ventilator is giving a positive pressure to the lungs, and the patient is creating with the expansion of her diaphragm or his/her chestspacewall a negative pressure in the lung. Thus we have two forces acting again