课件：Drager呼吸机应用.ppt

* * * * * Show as a summary AFTER the experiment! Larynx mask: ?Oesophagus“ valve Intrinsic PEEP also with closed filters, snappd of Tubes, ... * * * 由于自主呼吸和IPPV结合，可保证病人有效通气 * * * Pro and Contra + only 2 settings beside FiO2 and PEEP: flow assist and volume assist + good adaptation to patient effort = comfort + less need of paralysis and / or sedation + less likelihood of overventilation - difficult adjustment of parameters - dependence on spontaneous effort - pressure run-away - increased potential for ventilatory instability Flow assist:: Pressure Support (mbar) proportional (per) to inhaled flow (litre per second) Volume assist: Pressure Support (mbar) proportional (per) to inhaled volume (litre) The main difference to other support techniques lies in the fact that PPS and ATC calculate and generate the required pressure automatically and in real-time. Therefore the generated pressure support is directly proportional to the patient effort and asynchrony between patient effort and ventilator is minimised. The aim of PPS and ATC is to bring the ratio between patient effort and minute ventilation back to normal. * * ATC in every ventilation mode: how to set up ATC: type of tube inner diameter of tube amount of compensation in % and switch on Literature: 1 Respiratory comfort of automatic tube compensation and inspiratorypressure support in conscious humansGuttmann, J. et al , Intensive Care Medicine 1997, Vol. 23, No.11, 1119-1124 2 New Modes of Ventilatory Support in Spontaneously Breathing Intubated PatientsStocker et al, Yearbook of Intensive Care and Emergency Medicine 1997: 514-533 3 Breathing pattern and additional wob in spontaneously breathing patients with different ventilatory demands during inspiratory pressure support and automatic tube compensation Fabry, B. et al, Intensive Care Medicine 1997, Vol. 23, No.5, 545-552 4 Electronic Extubation - is it worth trying?Kuhlen, Roissant, Intensive Care Medicine 1997, Vol. 23, No.11, 110