美国重症医学FCCM的基础教程急性呼吸衰竭的诊断和管理.pptxVIP

美国重症医学FCCM的基础教程急性呼吸衰竭的诊断和管理第1页/共20页 ObjectivesDefine and classify acute respiratory failureDescribe pathophysiology of acute respiratory failureDiscuss clinical manifestations Review oxygen supplementation strategiesDiscuss noninvasive positive-pressure ventilationARF 2 ?第2页/共20页 Acute Respiratory FailureHypoxemicRoom air PaO2 ? 50 torr (6.7 kPa)HypercapnicPaCO2 ? 50 torr (6.7 kPa)Acute vs chronic –第3页/共20页 Pathophysiology of HypoxemiaVentilation/perfusion mismatchShunt effectDecreased diffusion of O2 Alveolar hypoventilationHigh altitude第4页/共20页 Pathophysiology of HypercapniaDecreased tidal volume and/or respiratory rate Inability to sense elevated PaCO2 Inability to signal effector mechanisms Inability to effect a response from respiratory muscles第5页/共20页 Increased Dead SpaceHypovolemiaLow cardiac outputPulmonary embolusHigh airway pressuresShort-term compensation by increasing tidal volume and/or respiratory rate第6页/共20页 Manifestations of Respiratory DistressAltered mental statusIncreased work of breathingTachypneaAccessory muscle use, retractions, paradoxical breathing pattern Catecholamine releaseTachycardia, diaphoresis, hypertensionAbnormal arterial blood gas valuesARF 7 ?第7页/共20页 Acute Respiratory Failure ManagementOxygen supplementationIncrease FIO2Match flow between delivery device and inspiratory demandHigh- vs. low-oxygen systemsHigh- vs. low-flow systemsARF 8 ?第8页/共20页 Nasal Cannula100% oxygen deliveredLow flow 0.5–5.0 L/minLow oxygen FIO2 0.4–0.5第9页/共20页 Air-Entrainment Face Mask100% O2 + entrainment deviceHigh flowVariable oxygenFIO2 0.24–0.5第10页/共20页 Aerosol Face Mask100% O2 + large-bore tubingNebulizer/O2 blenderFlow matchingIf mist disappears in inspiration, air is entrainedModerate-flow, variable FIO2 device第11页/共20页 Reservoir Face MaskReservoir bag filled with 100% O2High oxygen High flow 第12页/共20页 Resuscitation Bag-Mask-Valve Device100% O2 High flow ( 15 L/min)Emergency equipmentLittle to no air entrainm