機械通氣的模式ppt課件-資料下載頁
2025-01-19 01:22本頁面
【正文】 It provides the best way to improve patientventilator synchrony Potential advantages of PAV+ ? Synchrony between patient and ventilator ? Observation of elastance and resistance changes during the weaning trail ? Adaptability of ventilator to changing patient respiratory system mechanics (Kondili et al. Intensive Care Med 2022。32:692) PAV+ 90% Patient brain Physician brain Information Response PAV+ is a simple mode The physician just sets the % of support, FIO2 and PEEP and the ventilator is responsible for the synchrony D. Geopoulos, Intensive Care Med. 2022 Jul 8. D. Geopoulos, Intensive Care Med. 2022 Jul 8. Alveolar Ventilation Oxy. Tp Rate Pinsp Ti Te PF FiO2 PEEP Vt CMV SIMV PCV PSV Conventional FiO2 PEEP MV Automatic Automatic ventilation ?Pinsp ?RRIMV ?Pinsp ?RRIMV ?Pinsp ?RRIMV ? Pinsp ? RRIMV (PmaxPEEP)*Cdyn 5 b/min 20/RCexp 2*Vd Adaptive Support Ventilation Pmax Trigger IBW (Kg) FiO2 PEEP MinVol Controls Alarms Controls in ASV Sultzer, Anesthesiology, 2022 Petter, Anesth Analgesia, 2022 012345M a ni pu l a t i on s( n)P S V S w i t c he s( n)H i gh P re s s ureA l a rm s ( n)C on t rolA S VHow good is ASV? Operator/ventilator activity Tasseaux, CCM 2022 Patient fort How good is ASV? ASV: only 100 ASV: only 34 89 ASV: which patient? Prospective study: 7 months period 1349 days of invasive ventilation Arnal JM. Intensive Care Med 2022。 30: S84 (abstract) A SV : 9 8 %V A C : 0 . 5 %H O M E : 1 %P S V : 0 . 5 %A L I: 1 8 %C O P D : 1 6 %S t i f f : 4 %A R D S : 1 0 %N a l: 5 2 %NAVA NAVA NAVA Estimated Ppeak (Pest) in NAVA = = NAVA Level x (Edi peak – Edi min) + PEEP P (c m H2O)Ed i ( μ V )2010102010. 524NAVA level Ppeak (Pest) in NAVA = = NAVA Level x (Edi peak – Edi min) + PEEP SmartCare的控制機理 ? 撤機的基礎(chǔ)是輔助支持通氣 (pressure support) ? 調(diào)節(jié)的基礎(chǔ)是壓力支持的水平 (實時采集信息 IF ) VT fspont etCO2 呼吸穩(wěn)定 : PS ? PS ? 撤機 : PS ? Closed loop ventilation Patient Ventilator SmartCare 如何工作？ 基本原理 病人 : 血流動力學(xué)穩(wěn)定 , 自主呼吸活躍 只限于壓力支持模式 自動調(diào)節(jié)的參數(shù)是 PS值 主要監(jiān)測的參數(shù) : f_spn, VT, etCO2 f_spn VT etCO2 通氣分類 PS值調(diào)節(jié) SmartCare 如何工作？ ? 調(diào)節(jié) PS 維持病人呼吸于 “ 舒適區(qū)” ? 呼吸 “舒適區(qū) ” 表現(xiàn)于 “ 正常通氣”這項分類 呼吸舒適區(qū) f_spn VT etCO2 f_spn = 15 – 30 (神經(jīng)功能紊亂 1534) etCO2 55 mmHg(COPD65mmHg) Vt 300 ml (體重 55Kg者 Vt250ml) 有關(guān) Draeger自動脫機系統(tǒng)多中心測試的論文摘要 結(jié)論 : ?基于計算機技術(shù)的專家型系統(tǒng)不僅安全 , 而且與傳統(tǒng)脫機方法比較 , 能顯著縮短機械通氣時間和 ICU滯留時間 .“ 發(fā)表于 2022年柏林 ESICM. SmartCare 論文摘要 ESICM Berlin
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