机械通气常见问题处理__培训课件.pptVIP

The problem is further exacerbated by the vasodilatory and myocardial depressant effects of drugs used to induce anaesthesia and allow intubation and ventilation. Fortunately these effects are usually short lived and in most cases the hypotension responds to fluid infusion [hypotension03] Dynamic hyperinflation due to gas trapping is a less common but nevertheless important cause of hypotension. Gas trapping occurs if there is insufficient time for alveoli to empty before the next breath and may occur as a result of over-enthusiastic manual ventilation of the patient. It is more common in patients with asthma or chronic obstructive airways disease who have an obstruction to expiratory flow. The net result is progressive hyperinflation of the lung with a corresponding increase in pleural pressure. This results in a fall in venous return and if severe enough can result in cardiac arrest. The simplest way of diagnosing and treating this problem is to disconnect the patient from the ventilator. The diagnosis is confirmed by an immediate rise in blood pressure. [hypotension07] Finally, always consider the possibility of tension pneumothorax. Although this is a relatively rare cause of hypotension following the initiation of mechanical ventilation it is important not to miss this diagnosis as it is both life-threatening and easily treated by needle thoracostomy.[hypotension08] 有问题吗？ 低血压 低血压 容量不足 胸腔内正压 低血压 容量不足 药物 扩张血管 抑制心肌 低血压 容量不足 药物 动态过度充气（PEEPi） Time Pleural pressure 过度充气 Lung volume Time 低血压 容量不足 药物 动态过度充气 张力性气胸 In this tutorial on troubleshooting mechanical ventilation I am going to cover four main problems: hypotension, high airway pressure, patient-ventilator dysynchrony and arterial desaturation. The next step is to diagnose the problem and to work out whether it is a patient problem or whether it is an equipment problem. Look at the patient and check to see if he or she is cyanosed, like this lady and whether the chest is moving symmetrically. Check the satu