20xx年醫(yī)學(xué)專題—ards肺復(fù)張的實(shí)施(邱海波)-資料下載頁(yè)
2024-10-31 14:13本頁(yè)面
【正文】 PEEP: 20cmH2O 2. PEEP遞減(d236。jiǎn): 2cmH2O/5min 3. PEEP閾值: PaO2/FiO25% 4. PEEP: PEEP閾值 +2cmH2O,第三十三頁(yè)，共三十七頁(yè)。,BASELINE VENTILATION Tidal volume=6ml/kg PEEP=5cmH2O,Modify PEEP to get a 1.1ｂ0.9,recruiting maneuver,Measureｂ,,1.1ｂ0.9 Leave PEEP unchanged,ｂstress index 0.9,ｂ1.1 Decrease PEEP until 1.1stress index 0.9,Crit Care Med, 2004, 32: 10181027,肺開放(kāif224。ng)后的PEEP選擇 Stress index,第三十四頁(yè)，共三十七頁(yè)。,Implications,RM 的有效性 ALI的病因(b236。ngyīn) (direct vs in direct) Post RM PEEP Method in certain settings RM hazards are greatest and effectiveness least in pneumoniacaused acute lung injury PCV may be better tolerated than SI,第三十五頁(yè)，共三十七頁(yè)。,Recommendations,Use PCV in preference to SI Safer, “multiple〞, effective, maintains ventilation, simple Monitor hemodynamics during recruiting interval. 以下情況需重復(fù)作RM: 體位改變, 管路(ɡuǎn l249。)斷開, 呼吸力學(xué)特征或PaO2明顯惡化 對(duì)于頑固性難治性ARDS患者, 可考慮反復(fù)RM和更高的壓力 Employ Prone Position and/or PEEP to consolidate RM benefit.,第三十六頁(yè)，共三十七頁(yè)。,內(nèi)容(n232。ir243。ng)總結(jié),邱海波(hǎi bō)。肺保護(hù)性通氣策略不能解決解決的問題。Ventilatorassociated lung injury。Lachmann. ICM, 1994。C. Surfactant 滅活。Some units can’t。28 mixedbreed pigs。Models of ARDS:。肺開放后的PEEP選擇 Stress index。Post RM PEEP,第三十七頁(yè)，共三十七
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