呼吸监测与机械通气治疗(1急诊)精品.ppt

呼气末二氧化碳 End tidal CO2， ETCO2 又称潮气末二氧化碳 经气管导管测呼气中CO2 较PaCO2低6mmHg 意义： 反映通气量的灵敏指标 尤其在设定机械通气参数时有价值 呼气末二氧化碳（PETCO2） I 吸气相(inspiration) II 呼气上升相(expiratory upstroke) III 呼气平台相(expiratory plateau) IV 吸气下降相(inspiratory downstroke) 吸氧浓度(FIO2) 空气氧浓度为21% 故呼吸空气时，FIO2为 0.21 机械通气，可调范围0.20~1.00 FIO2超过0.60(0.70)，可能发生氧中毒 PaO2与FIO2 正相关 吸氧分数 PaO2/FIO2 正常人呼吸空气时PaO2/FIO2 ＞300 PaO2/FIO2 ＜300可能有急性肺损伤 * * 氧气从肺泡向血液弥散，要依次经过肺泡内表面的液膜、肺泡上皮细胞膜、肺泡上皮与肺毛细血管内皮之间的间质、毛细血管的内皮细胞膜等四层膜。这四层膜合称为呼吸膜。呼吸膜平均厚度不到1微米，有很高的通透性，故气体交换十分迅速 . * Standard care of the patient with severe sepsis consists of a number of medical (and sometimes surgical) interventions intended to normalize physiology and eliminate infection. These are divided into: Source control: This term refers to management of the source of the infection. It can consist of surgery to drain an abscess or removal of an infected catheter. Antibiotics: While the initial therapy may be broad-based and empiric, identification of the specific pathogen by microbiologic studies may result in a switch of the antibiotic to those that are the most specific and bacteriocidal. Hemodynamic support: This term refers to volume replenishment therapy followed, when necessary, by appropriate use of drugs such as norepinephrine to maintain blood pressure and organ perfusion. Mechanical ventilation: Respiratory failure is a common manifestation of pulmonary organ dysfunction in patients with severe sepsis. Mechanical ventilation is instituted to increase oxygenation and improve gas exchange. Renal replacement therapy: Impaired renal function is a sign of organ dysfunction in patients with severe sepsis. Renal replacement therapy consists of temporary hemodialysis or ultrafiltration. Sedation and analgesia: Sedation is often required to treat anxiety and agitation in patients with severe sepsis. Because these patients are at risk for pain and physical discomfort, analgesics also are commonly employed. Ensure adequate nutrition: Sepsis is a hypercatab