呼吸机波形分析课件_11

Waveform Monitoring of the Mechanically Ventilated Patient Tim Opt Holt, Ed.D., R.R.T. Professor Cardiorespiratory Care University of South Alabama How ventilator works? Basic Concepts Resistance = Pressure / Flow Compliance = Volume / Pressure Flow = Volume / Time Objectives vDescribe the volume, pressure and flow versus time scalars. vDescribe the use of scalars in the management of the mechanically ventilated patient. vDescribe the flow-volume and pressure-volume loops as they are used in the mechanically ventilated patient. vDescribe how loops are used to diagnose and manage problems in patients receiving mechanical ventilation Monitoring Techniques Used During Mechanical Ventilation vVentilator waveforms vpressure, volume and flow vs time scalars vflow-volume and pressure volume loops vAllows analysis of vauto-PEEP, bronchodilator response, hyper- expansion, adequacy of flow, ventilator sensitivity, compliance, and leaks Ventilator Waveforms vScalars vVolume versus time vPressure versus time vFlow versus time vLoops vFlow-Volume vPressure -Volume Flow versus Time ACCELERATINGACCELERATING DECELERATINGDECELERATING SINESINE SQUARESQUARE Volume vs Time InspirationInspiration Expiration Time (sec)Time (sec) Volume (ml)Volume (ml) Inspiratory Tidal Volume T TI I Pressure versus Time Inspiration Expiration Paw (cm H2O) Time (sec) TI Peak Inspiratory Pressure PIP PEEPPEEP TE Pressure-Volume Loop ControlledAssistedSpontaneous Vol (ml) Paw (cm H2O) I: Inspiration E: Expiration I E E E I I Flow-Volume Loop Volume (ml)Volume (ml) PEFR FRC Inspiration Expiration Flow (L/min)Flow (L/min) PIFR VT Pathological Conditions Air trapping and auto-PEEP Air Trapping Inspiration Expiration NormalNormal PatientPatient Time (sec) Flow (L/min) Air Trapping Auto-PEEP Air Trapping Inspiration Expiration Volume (ml)Volume (ml) Flow (L/min) Does not returnDoes not return to baselineto baseline Normal Abnormal Pathological Conditions Increased airway resistance Paw (cm HPaw (cm H 2 2 O)O) Normal Normal PPlat (Normal Compliance) Increased PIP Increased PTA (increased Airway Resistance ) ) NormalNormal PIPPIP P P PlatPlat High RHigh Raw aw PIPPIP P P PlatPlat Increased Airway Resistance Increased Airway Resistance Inspiration Expiration VolumeVolume (ml) (ml) Flow (L/min) Decreased PEFR NormalNormal Abnormal “Scooped out” pattern Pathological Conditions Response to Bronchodilator Response to Bronchodilator Before Time (sec) Flow (L/min) PEFR After Long TE Higher PEFR Shorter TE Pathological Conditions Overdistension Overdistension Volume (ml) Pressure (cm HPressure (cm H 2 2 O)O) With little or no change in VT Paw rises Normal Abnormal Pathological Conditions Inadequate Inspiratory Flow (Air Hungary) Inadequate Inspiratory Flow Adequate Flow Time (sec) Inadequate Flow Paw (cm H2O) Inadequate Inspiratory Flow Flow (L/min) Time (sec) Normal Abnormal Active Inspiration or AsynchronyActive Inspiration or Asynchrony Patients effort Pathological Conditions Inadequate Sensitivity Inadequate Sensitivity Volume Volume (mL)(mL) P P awaw (cm H (cm H 2 2 O)O) Increased WOB Pathological Conditions Decreased Compliance DECREASED COMPLIANCE Time (sec) Paw (cm H2O) Low Compliance PIP PPlat NormalNormal PIP PPlat Normal PPlat (Normal Compliance) Increased PPlat (Decreased Compliance ) ) Normal PIP Lung Compliance Changes and the P-V Loop Volume (mL)Volume (mL) Preset PIP VT levels P P awaw (cm H (cm H 2 2 O)O) COMPLIANCE Increased Normal Decreased Pressure Targeted Ventilation Pathological Conditions Air Leak Air Leak Volume (ml)Volume (ml) Time (sec)Time (sec) Air LeakAir Leak