压力支持通气ppt课件

1、.,1,压力支持通气压力目标/容量目标,解放军总医院呼吸病中心 解立新,.,2,Pulmonary and critical care medicine -a peculiarly American hybrid？,Tobin, MJ. Thorax 1999;54:286287,.,3,现代机械通气的发展历程,Current Anaesthesia 44(1):1-2,.,8,国内RICU的情况,国内目前主要有两种情况：RICU（Respiratory ICU）：代表单位有301医院、北京朝阳医院等,.,9,国内的情况,国内目前主要有两种情况： 综合ICU：代表医院有广州医学院第一附属医院等

2、,.,10,呼吸模式,控制模式 Controlled ventilation 2. 支持模式 Supported ventilation 3. 自主呼吸 Spontaneous breathing 4. 混合模式 Combined control and supported or spontaneous and supported ventilation,.,11,理想的压力支持通气,.,12,理想的支持通气,VA, volume assist,Best Practice 174:894900,CDW: computer-driven weaning,.,46,Smart Care,Am J

3、Respir Crit Care Med. 2006; 174:894900,Weaning protocol: computer-driven vs. Physician controlled,.,47,Smart Care,Kaplan-Meier analysis of weaning time until successful extubation or death after inclusion for all included patients in each study group,Weaning protocol: computer-driven vs. Physician c

4、ontrolled,Am J Respir Crit Care Med. 2006; 174:894900,.,48,Smart Care,Am J Respir Crit Care Med. 2006; 174:894900,Conclusions: The specific computer-driven system used in this study can reduce mechanical ventilation duration and ICU length of stay, as compared with a physician-controlled weaning pro

5、cess,Weaning protoccol: computer-driven vs. Physician controlled,.,49,总结,In the future, the ventilators will adapt themselves to the patient and not the reverse,Best Practice 174:894900,.,50,Current Status of Respiratory Critical Care,RICU: Respiratory Intensive Care Unit RICU : Respiratory Intermed

6、iate Care Unit RMU : Respiratory Monitoring Unit,Arch Bronconeumol. 2008;44(1):1-2,.,51,Definition of “RICUs”,Respiratory Intermediate Care units (RICUs) is an area for monitoring and treating patients with acute or exacerbated chronic respiratory failure caused primarily by a respiratory disease Ca

7、rdiorespiratory monitoring or treatment of respiratory failure with NIV Continuous monitoring of patients following thoracic surgery and of tracheostomized patients Treatment of critical patients whose weaning from invasive ventilation is difficult,Arch Bronconeumol. 2008;44(1):1-2,.,52,The Respirat

8、ory Medicine Status in ICU,Criteria adopted by the components of Task Force in order to define a respiratory intermediate care unit,Eur Respir J 2002; 20:1343-1350,.,53,The Respiratory Medicine Status in ICU,Definition of the three levels of care,Eur Respir J 2002; 20:1343-1350,.,54,RICU未来的发展方向,RICU应向MICU（Medical Intensive Care Unit）发展，收 治对象应涵盖内科各种合并感染的危重症患者（不包括急性心肌梗塞患者，但是如果合并感染亦应收治） 但是人才梯队的建设也是当务之急 Our Aim: Provide principal care for all patients in (medical) ICUs. -ATS Statemen