医技学院华盛顿医疗手册培训重症监护.pptxVIP

医技学院华盛顿医疗手册培训重症监护第1页/共53页 ContentsRespiratory FailureShock第2页/共53页 Respiratory Failure第3页/共53页 General PrinciplesHypercapnic respiratory failure may produce a respiratory acidosis (pH 7.35).Hypoxic respiratory failure can result in hypoxemia (arterial oxygen tension [PaO2] 60 mm Hg or arterial oxygen saturation [SaO2] 90%). The acute respiratory distress syndrome (ARDS) is a form of hypoxic respiratory failure caused by acute lung injury. The common end result is disruption of the alveolar capillary membrane, leading to increased vascular permeability and accumulation of inflammatory cells and protein-rich edema fluid within the alveolar space.The American-European Consensus Conference has defined ARDS as follows: (a) acute bilateral pulmonary infiltrates, (b) ratio of PaO2 to inspired oxygen concentration (FIO2) 200, and (c) no evidence for heart failure or volume overload as the principal cause of the pulmonary infiltrates (NEJM 2000;342:1334).第4页/共53页 PathophysiologyHypercapnic Respiratory Failure↑CO2 production ↑Dead space↓Minute volumeFever, Sepsis, Lung diseaseCOPD, asthma, scolisisNerve, muscle, overdose第5页/共53页 PathophysiologyHypoxic Respiratory FailureShuntV/Q mismatch↓Ventilation↓oxygenDiffusion impairment↓SvO2第6页/共53页 Causes of shunts and hypoxic respiratory failureCardiaogenic pulmonary edemaAMILV faulureMitral regurgitationMitral stenosisDiastolic disfunctionNon-cardiogenice pulmonary edemaAspirationSepsisMultiple traumaPancreatitisPneumoniaMixed pulmonary edemaMyocardial ischemiaHigh-latitude exposureOther pulmonary edemaUpper airway obstructionNeurogenic causeLung reexpansion第7页/共53页 Noninvasive oxygen therapyNasal prongVenturi maskNonrebreathing maskCPAP maskBiPAP第8页/共53页 Airway managementHead and jaw positioning第9页/共53页 Airway managementOral and nasopharyngeal tube第10页/共53页 Airway managementOral and nasopharyngeal tube第11页/共53页 Airway managementLaryngeal mask airway第12页/共53页 Airway managementMask-to-face Ventilation第13页/共53页 Endotracheal intub