【正文】 間太久 ， 吸痰管負(fù)壓太大 , 吸痰管 選擇不當(dāng)， 人機(jī)對抗 ，采用的模式不適應(yīng) 。 ?③氣囊破損漏氣致通氣量缺乏。拔管太早 ,多見全麻術(shù)后病人 ,未完全清醒 ,呼吸不暢 ,咳痰無力 ,吸痰不徹底 ,痰栓堵塞。 ?導(dǎo)管更換不勤 ,大量細(xì)菌附著 。其上升速度不應(yīng)超過 10mmHg/ h , 緩慢增加的目的在 于細(xì)胞內(nèi)部酸性物質(zhì)可以充分代償。 ?控制通氣 ( PCV ) 、 ?壓力支持通氣 (/ASB/PSV) , ?雙相氣道正壓 (BIPAP) 、 ?壓力調(diào)節(jié)容量控制 ( PRVC) 。 肺保護(hù)性通氣策略 第四十二頁，共五十六頁。 RM和 PEEP對肺泡容積和肺穩(wěn)定性的影響 Figure 7. Alveolar number ( Alveoli/Field) and alveolar stability (IE) before (before RM), during (during RM), and after a recruitment maneuver (RM) with either 5 (positive endexpiratory pressure [PEEP] 5 after RM) or 10 (PEEP 10 after RM) cm H2O PEEP added. Note that with only 5 cm H2O PEEP after RM (PEEP 5 after RM) that alveoli recollapse (fall in alveoli/field) and the alveoli that remain open were unstable (increased IE). Adding PEEP (PEEP 10 after RM) prevented both recollapse and instability. from Am J Respir Crit Care Med (29).) 第三十九頁，共五十六頁。 ZEEP, 0 positive endexpiratory pressure。 第三十一頁，共五十六頁。 ? 氣體進(jìn)入肺循環(huán)那么引起氣體栓塞。 BIPAP Was Responsible For A 43% Reduction In Sedation T H E E F F E C T O F B I L E V E L M O D E O N O P I O I D U T I L I Z A T I O N I N AM E D I C A L I N T E N S I V E C A R E U N I T J o h n S a u l R R T , K e n H a r g e t t R R T , L i s a W e a v i n d M D , A n d r e w S h a w M D ,M e c h e l l e W i l l i a m s R N A N P C S , S u s a n n a h K i s h R N C S C C R N C P A NT h e U n i v e r s i t y o f T e x a s M D A n d e r s o n C a n c e r C e n t e r , H o u s t o n , T e x a sI n t r o d u c t i o n : T h e u s e o f a n a l g e s i a o n m e c h a n i c a l l y v e n t i l a t e d p a t i e n t s i s ac o m m o n p r a c t i c e i n t h e m e d i c a l I C U . A n a l g e s i a m a n a g e m e n t i s g e n e r a l l yre la te d to th e p a tie n ts’ d y s y n c h r o n y a n d a g i t a t i o n o n t h e v e n t i l a t o r . A n e wm o d e o f v e n t i l a t i o n ( B i L e v e l ) w a s i n t r o d u c e d t h a t s h o u l d a l l o w t h e p a t i e n t t ob e m o r e c o m f o r t a b l e . T h e c u r r e n t s t u d y c o m p a r e d t h e u s e o f o p i o i d i n M I C Up a t i e n t s b e f o r e a n d a f t e r t h e i n t r o d u c t i o n o f t h e n e w m o d e . M e t h o d s : A s t u d yd o n e i n o u r I C U p r i o r t o t h e i n t r o d u c t i o n o f B i L e v e l q u a n t i t a t e d t h e a m o u n t o fo p i o i d u s e o n m e c h a n i c a l l y v e n t i l a t e d p a t i e n t s . A t t h a t t i m e t h e m o d e o fv e n t i l a t i o n w a s a c o m b i n a t i o n o f A s s i s t C o n t r o l o r S I M V w i t h P r e s s u r eS u p p o r t . T h i s s t u d y w a s u s e d a s t h e b a s e l i n e f o r c o m p a r i s o n . T h e d a t ac o l l e c t i o n m e t h o d s o f t h e p r e v i o u s s t u d y w e r e d u p l i c a t e d o n 10 c o n s e c u t i v ep a t i e n t s v e n t i l a t e d w i t h B i L e v e l . O p i o i d u s a g e w a s c o l l e c t e d o n d a y 1 , 2 , 3 a n dd a y 7 a f t e r i n s t i t u t i o n o f m e c h a n i c a l v e n t i l a t i o n . A l l o p i o i d d o s a g e s w e r ec o n v e r t e d t o a n e q u i v a l e n t p a r e n t e r a l d o s e o f m o r p h i n e s u l f a t e f o r c o m p a r i s o n .T h e d a t a w a s a n a l y z e d u s i n g a t w o t a i l e d u n p a i r e d t t e s t . R e s u l t s : P a t i e n t s i nt h e t w o g r o u p s h a d s i m i l a r d e m o g r a p h i c s . C u r r e n t g r o u p m e a n a g e w a s 57 a n di n t h e b a s e l i n e g r o u p m e a n a g e w a s 5 3 . F e m a l e s c o m p r i s e d 5 6 % o f t h e