机械通气总论PPT学习教案

1、会计学1机械通气总论机械通气总论常用的机械通气模式2机械通气常见问题的处理34常见疾病的机械通气策略机械通气的历史1第1页/共127页第2页/共127页第3页/共127页第4页/共127页第5页/共127页第6页/共127页第7页/共127页第8页/共127页第9页/共127页第10页/共127页Mechanical Ventilation第11页/共127页The iron lung created negative pressure in abdomen as well as the chest, decreasing cardiac output.Iron lung polio ward

2、 at Rancho Los Amigos Hospital in 1953.第12页/共127页机械通气常见问题的处理34常见疾病的机械通气策略机械通气的历史1常用的机械通气模式2第13页/共127页Esteban A, Anzueto A, Alia I, et al. How Is Mechanical Ventilation Employed in the Intensive Care Unit? An International Utilization Review. Am J Respir Crit Care Med 2000; 161: 1450-1458第14页/共127页Es

3、teban A, Anzueto A, Alia I, et al. How Is Mechanical Ventilation Employed in the Intensive Care Unit? An International Utilization Review. Am J Respir Crit Care Med 2000; 161: 1450-1458第15页/共127页1. Esteban A, Alia I, Ibanez J, et al. Modes of mechanical ventilation and weaning. A national survey of

4、Spanish hospitals. Chest 1994; 106: 1188-1193; 2. Esteban A, Anzueto A, Alia I, et al. How is mechanical ventilation employed in the Intensive Care Units? An international utilization review. Am J Respir Crit Care Med 2000; 161: 1450-1458; 3. Esteban A, Anzueto A, Frutos F, et al. Characteristics an

5、d outcomes in adult patients receiving mechanical ventilation. JAMA 2002; 287: 345-355第16页/共127页第17页/共127页Esteban (1992)Esteban (1996)Esteban (1998)VCV55%47%53%PCV1%5%SIMV26%6%8%SIMV + PSV8%25%15%PSV8%15%4%其他模式2%7%15%1. Esteban A, Alia I, Ibanez J, et al. Modes of mechanical ventilation and weaning.

6、 A national survey of Spanish hospitals. Chest 1994; 106: 1188-1193; 2. Esteban A, Anzueto A, Alia I, et al. How is mechanical ventilation employed in the Intensive Care Units? An international utilization review. Am J Respir Crit Care Med 2000; 161: 1450-1458; 3. Esteban A, Anzueto A, Frutos F, et

7、al. Characteristics and outcomes in adult patients receiving mechanical ventilation. JAMA 2002; 287: 345-355第18页/共127页2Esteban A, Anzueto A, Alia I, et al. How Is Mechanical Ventilation Employed in the Intensive Care Unit? An International Utilization Review. Am J Respir Crit Care Med 2000; 161: 145

8、0-1458第19页/共127页第20页/共127页第21页/共127页ExpirationInspiratory Tidal Volume第22页/共127页InspirationExpirationPaw (cm H2O)Time (sec)TIPeak Inspiratory PressurePIPTE第23页/共127页第24页/共127页第25页/共127页第26页/共127页第27页/共127页TbTbTbVIMPIMVIMTb = 60/fThe ventilator monitors time intervals from a specific event (for examp

9、le, triggering a PIM or the transition from inspiration to exhalation.) During A/C in the absence of patient effort, the ventilator delivers one inspiration at the beginning of every breath period, as shown in figure. Such a breath is called a ventilator-initiated mandatory (VIM) breath. If the patients inspiratory efforts generate a pressure or flow trigger before the breath cycle has elapsed, the ventilator delivers a PIM.第28页/共127页1t1.吸气相根据预置的呼吸频率或当患者触发时开始第29页/共127页第30页/共127页P (cmH