機(jī)械通氣總論P(yáng)PT學(xué)習(xí)教案

1、會計學(xué)1機(jī)械通氣總論機(jī)械通氣總論常用的機(jī)械通氣模式2機(jī)械通氣常見問題的處理34常見疾病的機(jī)械通氣策略機(jī)械通氣的歷史1第1頁/共127頁第2頁/共127頁第3頁/共127頁第4頁/共127頁第5頁/共127頁第6頁/共127頁第7頁/共127頁第8頁/共127頁第9頁/共127頁第10頁/共127頁Mechanical Ventilation第11頁/共127頁The iron lung created negative pressure in abdomen as well as the chest, decreasing cardiac output.Iron lung polio ward

2、 at Rancho Los Amigos Hospital in 1953.第12頁/共127頁機(jī)械通氣常見問題的處理34常見疾病的機(jī)械通氣策略機(jī)械通氣的歷史1常用的機(jī)械通氣模式2第13頁/共127頁Esteban A, Anzueto A, Alia I, et al. How Is Mechanical Ventilation Employed in the Intensive Care Unit? An International Utilization Review. Am J Respir Crit Care Med 2000; 161: 1450-1458第14頁/共127頁Es

3、teban A, Anzueto A, Alia I, et al. How Is Mechanical Ventilation Employed in the Intensive Care Unit? An International Utilization Review. Am J Respir Crit Care Med 2000; 161: 1450-1458第15頁/共127頁1. Esteban A, Alia I, Ibanez J, et al. Modes of mechanical ventilation and weaning. A national survey of

4、Spanish hospitals. Chest 1994; 106: 1188-1193; 2. Esteban A, Anzueto A, Alia I, et al. How is mechanical ventilation employed in the Intensive Care Units? An international utilization review. Am J Respir Crit Care Med 2000; 161: 1450-1458; 3. Esteban A, Anzueto A, Frutos F, et al. Characteristics an

5、d outcomes in adult patients receiving mechanical ventilation. JAMA 2002; 287: 345-355第16頁/共127頁第17頁/共127頁Esteban (1992)Esteban (1996)Esteban (1998)VCV55%47%53%PCV1%5%SIMV26%6%8%SIMV + PSV8%25%15%PSV8%15%4%其他模式2%7%15%1. Esteban A, Alia I, Ibanez J, et al. Modes of mechanical ventilation and weaning.

6、 A national survey of Spanish hospitals. Chest 1994; 106: 1188-1193; 2. Esteban A, Anzueto A, Alia I, et al. How is mechanical ventilation employed in the Intensive Care Units? An international utilization review. Am J Respir Crit Care Med 2000; 161: 1450-1458; 3. Esteban A, Anzueto A, Frutos F, et

7、al. Characteristics and outcomes in adult patients receiving mechanical ventilation. JAMA 2002; 287: 345-355第18頁/共127頁2Esteban A, Anzueto A, Alia I, et al. How Is Mechanical Ventilation Employed in the Intensive Care Unit? An International Utilization Review. Am J Respir Crit Care Med 2000; 161: 145

8、0-1458第19頁/共127頁第20頁/共127頁第21頁/共127頁ExpirationInspiratory Tidal Volume第22頁/共127頁InspirationExpirationPaw (cm H2O)Time (sec)TIPeak Inspiratory PressurePIPTE第23頁/共127頁第24頁/共127頁第25頁/共127頁第26頁/共127頁第27頁/共127頁TbTbTbVIMPIMVIMTb = 60/fThe ventilator monitors time intervals from a specific event (for examp

9、le, triggering a PIM or the transition from inspiration to exhalation.) During A/C in the absence of patient effort, the ventilator delivers one inspiration at the beginning of every breath period, as shown in figure. Such a breath is called a ventilator-initiated mandatory (VIM) breath. If the patients inspiratory efforts generate a pressure or flow trigger before the breath cycle has elapsed, the ventilator delivers a PIM.第28頁/共127頁1t1.吸氣相根據(jù)預(yù)置的呼吸頻率或當(dāng)患者觸發(fā)時開始第29頁/共127頁第30頁/共127頁P(yáng) (cmH