医、技学院(华盛顿医疗手册培训-重症监护).ppt

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1、TheWashingtonManualofMedicalTherapeutics--CriticalCAreDepartmentofCriticalCareCuiWeiContentsRespiratoryFailureShockRespiratoryFailureGeneralPrinciplesHypercapnicrespiratoryfailuremayproducearespiratoryacidosis(pH<7.35).Hypoxicrespiratoryfailurecanresultinhypoxemia(arterialoxygentension[P

2、aO2]<60mmHgorarterialoxygensaturation[SaO2]<90%).Theacuterespiratorydistresssyndrome(ARDS)isaformofhypoxicrespiratoryfailurecausedbyacutelunginjury.Thecommonendresultisdisruptionofthealveolarcapillarymembrane,leadingtoincreasedvascularpermeabilityandaccumulationofinflammatorycellsandprot

3、ein-richedemafluidwithinthealveolarspace.TheAmerican-EuropeanConsensusConferencehasdefinedARDSasfollows:(a)acutebilateralpulmonaryinfiltrates,(b)ratioofPaO2toinspiredoxygenconcentration(FIO2)<200,and(c)noevidenceforheartfailureorvolumeoverloadastheprincipalcauseofthepulmonaryinfiltrates(

4、NEJM2000;342:1334).PathophysiologyHypercapnicRespiratoryFailure↑CO2production↑Deadspace↓MinutevolumeFever,Sepsis,LungdiseaseCOPD,asthma,scolisisNerve,muscle,overdosePathophysiologyHypoxicRespiratoryFailureShuntV/Qmismatch↓Ventilation↓oxygenDiffusionimpairment↓SvO2Causesofshuntsandhypoxic

5、respiratoryfailureCardiaogenicpulmonaryedemaAMILVfaulureMitralregurgitationMitralstenosisDiastolicdisfunctionNon-cardiogenicepulmonaryedemaAspirationSepsisMultipletraumaPancreatitisPneumoniaMixedpulmonaryedemaMyocardialischemiaHigh-latitudeexposureOtherpulmonaryedemaUpperairwayobstructio

6、nNeurogeniccauseLungreexpansionNoninvasiveoxygentherapyNasalprongVenturimaskNonrebreathingmaskCPAPmaskBiPAPAirwaymanagementHeadandjawpositioningAirwaymanagementOralandnasopharyngealtubeAirwaymanagementOralandnasopharyngealtubeAirwaymanagementLaryngealmaskairwayAirwaymanagementMask-to-fac

7、eVentilationEndotrachealintubationIndicationInitiationofmechanicalventilationAirwayprotectionInadequateoxygenationusinglessinvasivemethodsPreventionofaspirationandallowingforthesuctioningofpulmonarysecretionsHyperventilationforthetreatmentofincreasedintracranialpressureEn