白春学-呼吸衰竭1课件

RespiratoryFailureBaiChunxueDepartmentofRespiratorydiseaseZhongshanHospitalFudanUniversityChapter7复旦呼研所1KeyWordsRespiratoryfailureAcuterespiratorydistresssyndrome(ARDS)dyspneaHypoxemiahypercapniaRespiratorySupportMechanicalventilationPositiveend-expiratorypressure(PEEP)复旦呼研所2

ACUTERESPIRATORYFAILUREBaiChun-XueDepartmentofRespiratorydiseasesZhongshanHospital复旦呼研所4TypeIParenchymaEdemaVasculardiseaseChestWall&PleuraldiseaseTypeIIAirwayobstructionNeuromusculardiseasePathogeny复旦呼研所6hypoxemiaPerfusionDiffusionVentilationCO2CO2O2O2ClinicalFindings复旦呼研所7PAO2，PACO2（kPa)hypercapniaCO2O2ClinicalFindings复旦呼研所8

cyanosis,restlessnessconfusion,anxiety,delirium

tachypnea,tachycardia

hypertension,cardiacarrhythmiastremorHypoxemia复旦呼研所9DiagnosisPaO2<8kPaPaCO2>6.66kPa复旦呼研所11specifictherapydirectedtowardtheunderlyingdisease;respiratorysupportivecaredirectedtowardthemaintenanceofadequategasexchange;generalsupportivecare.Treatment复旦呼研所12Nonventilatoryaspects

Ventilatoryaspects

A.RespiratorySupport复旦呼研所13SaO2of≥90%(PaO2about60mmHg).Hypoxemiainpatientswithobstructiveairwaydiseaseisusualeasilycorrectedbyusinglow-flowoxygenbynasalcannula(1–3L/min)orVenturimask(24–28%).HigherconcentrationsofoxygenarenecessarytocorrecthypoxemiainpatientswithARDS,pneumonia,andotherparenchymallungdiseases.Nonventilation复旦呼研所14经鼻面罩机械通气治疗前后血气变化（X±S）白春学,等.应用国产呼吸器经鼻面罩治疗慢性阻塞性肺病所致呼吸衰竭9例报告.上海医学1993;16:102复旦呼研所15HypoxemiawhichisnotquicklyreversedbysupplementaloxygenAirwayobstructionImpairedairwayprotectionInadequatehandlingofsecretionsFacilitationofmechanicalventilationTrachealintubation–Indications17Trachealintubation复旦呼研所18ApneaAcutehypercapniathatisnotquicklyreversedbyappropriatespecifictherapySeverehypoxemiaProgressivepatientfatiguedespiteappropriatetreatmentMechanicalventilation–Indications19Assistedmechanicalventilation(AMV)orassist/control(A/C)Synchronizedintermittentmandatoryventilation(SIMV)Pressuresupportventilation(PSV)Mechanicalventilation–Modes20Pressurecontrolventilation(PCV)Continuouspositiveairwaypressure(CPAP)Positiveend-expiratorypressure(PEEP)Mechanicalventilation–Modes21AtelectasisofthecentrolaterallungandoverdistentionoftheintubatedlungBarotrauma,manifestedbysubcutaneousemphysema,pneumomediastinum,subpleuralaircysts,pneumothorax,orsystemicgasembolismMechanicalventilation–Complications22NutritionPsychologicalandemotionalsupportSkincareMeticulousavoidanceofnosocomialinfectionandcomplicationsoftrachealtubesB.GeneralSupportiveCare复旦呼研所24Course&Prognosis复旦呼研所25ARDSassociatedwithsepsishasanextremelypoorprognosis,withmortalityratesofabout90%.Surv