美国呼吸衰竭治疗方案英文版.ppt

RESPIRATORY FAILUREMANAGEMENT Dr.Sivasubramanian.T.A. DEPARTMENT OF ANAESTHESIOLOGY IBRI REGIONAL REFERRAL HOSPITAL RESPIRATORY CARE Ambient Pressure Therapy Positive Pressure Therapy AMBIENT PRESSURE THERAPY Oxygen Therapy Humidity Therapy Bronchial Hygeine Therapy Pharmacotherapy OXYGEN THERAPY Oxygen Delivery = O2 Content x Cardiac Output O2 Content = Hb x SaO2 x 1.34 + PaO2 x 0.003 OXYGEN THERAPY Aims to improve PaO2 by increasing FiO2 Effective FiO2 - 0.24 - 0.50 FiO2 0.50 not indicated OXYGEN THERAPY Delivered by Variable Performance / Low Flow System Fixed Performance / High Flow System LOW FLOW SYSTEM LOW FLOW SYSTEM FiO2 depends on Size of O2 Reservoir O2 Flow Rate Breathing Pattern LOW FLOW SYSTEM Simplicity Patient Comfort Economical Inaccurate / Not dependable PERFORMANCE HIGH FLOW SYSTEM 3 - 4 times Minute Volume Accurate over a range of Minute Volume FiO2 0.24 - 0.40 Higher FiO2 by large-volume nebulisers HIGH FLOW SYSTEM HUMIDITY THERAPY HUMIDITY THERAPY Delivered by Humidifiers Nebulisers HMEs eg. Thermovent HUMIDIFIERS Water baths Supply heated, humidified air 100 % saturated Prevent water loss from lungs Cannot supply additional water NEBULISERS Aerosol mists Particle size 2 - 5 ?m Supply 150 - 1500 mg/L water Useful for liquefying dried secretions Deliver medications NEBULISERS Types: Venturi Ultrasound ULTRASONIC NEBULISER Water broken up by resonator Up to 6 ml in 1 min. Particle size ~ 2 ?m Can cause water overload Mainly used for medication HME Heat and Moisture exchanger Also called ‘Artificial nose’ Efficiency 70 % ↑ Resistance Bacteriostatic ? BRONCHIAL HYGEINE THERAPY Retained secretions can cause Atelectasis Pneumonia V/Q mismatch Hypoxaemia BRONCHIAL HYGEINE THERAPY Prophylactic: Chest Physiotherapy - Postural drainage, Chest percussion, Cough assist Incentive Spirometry Aerosol BRONCHIAL HYGEINE THERAPY Therapeutic: Endotracheal suctioning Fiberoptic Bronchoscopy Chest physiotherapy ENDOTRACHEAL SUCTION Harmful effects: Trauma