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ID:62190275
大小:5.09 MB
页数:54页
时间:2021-04-20
《最新通气策略 DISEASE-ORIENTED VENTILATION STRATEGIES教学讲义ppt课件.ppt》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、通气策略DISEASE-ORIENTEDVENTILATIONSTRATEGIESObjectivesofVentilationACCPStandards(Slutsky,1993)CLINICAL1.Reversehypoxemia2.Reverserespiratoryacidosis3.Relieverespiratorydistress4.Preventorreverseatelectasis5.ReverserespiratorymusclefatiguePRIMARYAvoidIatrogenicLungInjuryRespiratoryFailurePatholog
2、yOBSTRUCTIVE(Resistance)AsthmaBronchitisEmphysemaSmokeInhalationSmallETtubeRESTRICTIVE(LungCompliance)ARDSPneumoniasCHFPneumothoraxNeuromuscularAbdominaldistensionChestwalldeformityRESPIRATORYPUMPInspiration-thoraciccavityPressure-abdominalcavityPressureMECHANICALBREATHDELIVERYPositivePressu
3、reBreathDeliveryMechanicalVentilationREVERSESITIntrathoracicPressure??COPD/AsthmaAsthmaairwayresistance1.bronchospasm2.airwayedema3.secretionsCOPDterminalbronchiolecollapseduringexpirationbronchospasmsecretions(infection)ExpiratoryTimeConstantAirtrapping&auto-PEEPHyperinflatedlungsCXR-Hyperi
4、nflatedLungsPatientwithAirwayResistanceGasflowisgreatestwhereresistanceislow,henceoverinflationofnormallungunits.V/QPvCO2=46mmHgPvO2=40mmHgPaO2=70mmHgPaCO2=45mmHgPaCO2=43mmHgPaO2=60mmHg123456SEC120120V.LPMAutoPEEPWhatisit?Howdoyoumeasureit?Airtrappingandauto-PEEPCardiovascularCompromisefro
5、mAuto-PEEPCombinationof:highfillingpressures(PAP)reducedC.O.hypotensionMistakenforLEFTVENTRICULARFAILUREContinuedventilationPEAandcardiacarrestMartensetal,1993(Lancet);Kollef,1992(HeartLung);Mylesetal,1995(BrJAnaesth);Lapinsky&Leung,1996(NEJM)DetectingAuto-PEEP1.Waveforms(Flow,Pressure,Volume
6、)2.Expiratorypauseonventilator(passivepatient)3.Diff.b/wpt’sRRandtheventilator’sresponserate4.Esophagealballoonpressure5.Centralvenouspressureline6.Arterialpressureline7.Pulseoximetry(sometimes)Somecasesareveryobvious!PressureTriggeringwithAuto-PEEPPatienteffortsnotrecognizedbytheventilator-20
7、Paw(cmH20)Depictionofapatientexperiencingnoauto-PEEPTime(s)(L/min)123456V.120-120INSPEXHZeroflowatendexhalationindicatesequilibrationoflungandcircuitpressure,ie,noauto-PEEPFlowWaveformwithAuto-PEEPDepictionofapatientexperiencingauto-PEE
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