呼吸重症镇静.pptVIP

呼吸重症患者目标化镇静：个人体会;呼吸重症;呼吸重症机械通气患者;;呼吸重症患者的镇静目的;内容提要：呼吸重症患者的目标镇静;AECOPD患者的镇静;AECOPD患者的镇静;;AECOPD患者的镇静;AECOPD患者的镇静;AECOPD 镇静流程图;呼吸重症患者的目标镇静;ALI／ARDS 患者的镇静;;改善肺顺应性： 人机协调的问题，肌紧张问题 降低交感张力 减少MV相关肺损伤 避免镇静不良反应;ARDS：严重程度与MV支持条件;ALI/ARDS 镇静流程图;每日多次评估患者的机械通气条件 尽可能及时降低呼吸机条件至脱机。 每2小时评估相应需要的镇静深度 尽可能实现与保持与MV 条件相匹配的镇静深度目标，避免过浅或过度镇静。;Impact of ventilator adjustment and sedation-analgesia practices on severe asynchrony in patients ventilated in assist-control mode. Chanques G, Kress JP, Pohlman A, et al. ;CONCLUSIONS: Compared with increasing sedation-analgesia, adapting the ventilator to patient breathing effort reduces breath-stacking asynchrony significantly and often dramatically. These results support an algorithm beginning with ventilator adjustment to rationalize the management of severe breath-stacking asynchrony in ICU patients. ;Comment in Patient-ventilator asynchrony: adapt the ventilator, not the patient! [Crit Care Med. 2013] Crit Care Med. 2014 Jan;42(1):205-7. doi: 10.1097/CCM.0b013e3182a51ecd. How much sedation can those smart ventilators handle? Patient-ventilator synchrony revisited*. Tanios MA.;Reducing deep sedation and delirium in acute lung injury patients: a quality improvement project. Hager DN et al. We undertook an ICU-wide structured quality improvement project to decrease sedation and delirium. DESIGN: Prospective quality improvement project in comparison with a retrospective acute lung injury control group. SETTING: Sixteen-bed medical ICU in an academic teaching hospital with pre-existing use of goal-directed sedation with daily interruption of sedative infusions. PATIENTS: Consecutive acute lung injury patients. ;INTERVENTION;;镇静解决的呼吸生理问题不同 （中到重度） AECOPD:使患者耐受呼吸机治疗，即保持小气道开放之目的，尽可能保留自主呼吸、咳嗽反射和纤毛运动。 ARDS： 有效抑制自主呼吸（必要时肌松），最小程度保留咳嗽反射（改善肺顺应性和呼吸机机相关肺损伤）。;AECOPD 镇静：缺乏证据;;镇静剂带来的药物相关损害不同 AECOPD:气道反应性 ARDS： 炎症反应与免疫调节，过度镇静 (文献不足) ;镇静镇痛药物对支气管平滑肌的作用;AECOPD 镇静流程图;ALI/ARDS 镇静流程图;呼吸重症患者的目标镇静内容;镇静对于无创机械通气是非常重要的;多数医生对在NPPV期间使用镇静剂 ;