機械通氣的模式ppt課件-文庫吧資料
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【正文】 e a k i n s p i r a t o r y f l o w S i e m e n s S e r v o 9 0 0 2 5 % o f p e a k i n s p i r a t o r y f l o w V e r s a m e d i V e n t 2 5 % o f p e a k i n s p i r a t o r y f l o w N e w p o r t E 2 0 0 V a r i a b l e : ( ? + 223。25:514 Does the tubepensation function of two modern mechanical ventilators provide effective work of breathing relief? Critical Care October 2022 Vol 7 No 5 Maeda et al. Animal Lab on Synchrony Asia Vent Forum Shanghai TCI TC 100%, ETT Pcircuit Peso Pplural Ventilator Flow Patient Effort ? Artifact Trigger Occurrence of leak ? Missed Trigger ? Delayed Trigger 漏氣補償 Leak pensation, ALC Automatic Leak Compensation ? Effective Automatic Leak Compensation Occurrence of leak Ventilator Flow Patient Effort ? Patient Triggers Only Patient Trigger Patient Trigger Patient Trigger Patient Trigger Patient Trigger Patient Trigger Patient Trigger Patient Trigger 漏氣補償 Leak pensation, ALC ? 改善同步 ? 改善病人舒適度 ? 改善通氣的有效性 ? 減少因人 機不同步引起的病人作功增加 ? 減輕病人鎮(zhèn)靜深度 壓力上升時間與吸氣終止 1 2 3 4 5 6 30 Sec Paw cmH2O 10 Flow too low Risetime/Pressure slope, Esens Overshoot supraplateau Ti in PSV Inspiration termination Criteria (Esens) 25% of peak flow in most cases 以往呼吸機的固定 Esens Vent ila t o r F lo w Cy cling T hresh o ld A d u l t S t a r 2 5 % o f p e a k i n s p i r a t o r y f l o w B e a r 1 0 0 0 3 0 % o f p e a k i n s p i r a t o r y f l o w B i r d 8 4 0 0 2 5 % o f p e a k i n s p i r a t o r y f l o w D r 228。164:43 APRV ? No evidence to indicate that APRV is better than conventional ventilation ? 無依據(jù)證明 APRV優(yōu)于傳統(tǒng)的通氣模式 其它新的功能 ? 導管補償 TC, ATC ? 漏氣補償 Leak pensation, ALC ? 5種邏輯運算 , 2ms ? 保證病人吸氣觸發(fā)良好 ? 自動壓力上升時間與吸氣終止 (e500) ? PAV比例輔助通氣 (NPB 840) ? PPS比例壓力支持 (Evita 4, optional) TC,氣道阻力與流速的關系 05101520250 10 20 30 40 50 60 70 80Fl o w R a t eDelta P PS的局限性 在吸氣相早期，氣流流速快， PS可能支持不足 病人在清醒、入睡、焦慮等狀態(tài)下， PS的代償無法根據(jù)不同的需要而變化 10 PCIRC cmH2O INSP L min EXP 5 0 5 10 80 60 40 20 0 20 80 40 60 V . 0 4 8 12s 2 6 10 Higher Flow Insufficient Support TC/ATC ATC NBP840 W h a t 抯 N e w ?f1m i n1605V T R I G.3 . 7 5TH S1 . 7 51 . 7 51 :1 . 1 42 . 0P%50H2OPEEPH20cmO2%50TCcm% S U P P9 0 %VS E N SLm i n5B
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